Fentanyl: use, abuse, addiction and harm

ABC’s Background Briefing have recently looked critically at the rise in prescription of fentanyl and associated addiction, harm and fatal overdose.

A national emergency Pt. 1 (May 20th, 2018) reviews issues covered in Prescription killer: Australia’s imminent fentanyl epidemic (November 2017).

The programme summary from Pt. 1 of A national emergency follows;

Alarming numbers of Australians are dying from fentanyl overdoses at increasing rates and undercover recordings show just how easy it is to get it.

A NSW coronial inquest into the deaths of six people has just found double the amount of people die from prescription opioids than they do from heroin.

In the first of a two part investigation, reporter Hagar Cohen revisits a story first broadcast last year, she speaks to people whose lives have been torn apart by fentanyl abuse.

You can also listen to the programme below. (33.5 MB) © ABC Background Briefing;

Or download the mp3 file here.

 

On May 27th, 2018 Background Briefing presented A national emergency Pt. 2. The programme summary follows (bold mine);

Paramedics across Australia are stealing lethal opioids to cope with workplace trauma.

Freedom of Information documents reveal nearly 100 investigations into the misappropriation of addictive drugs by ambulance workers since 2010.

In this co-production with the 730 program, reporter Hagar Cohen asks why paramedics have stolen fentanyl for personal use.

A warning, this episode deals extensively with suicide. It might not be suitable for everyone and if it brings up any issues at all for you please contact Lifeline on 13 11 14.

You can access the audio above or use the player below. (35.8 MB) © ABC Background Briefing;

Or download the mp3 file here.

 

The opening summary from last year’s Prescription killer: Australia’s imminent fentanyl epidemic is as follows;

Fentanyl is the prescription opioid so deadly a dose the size of ten grains of sand can kill you.

In the US it’s fuelling a national emergency, making up a third of all drug overdoses there.

New exclusive figures show alarming numbers of Australians are dying from fentanyl overdoses at increasing rate.

Undercover recordings show just how easy it is to get. Hagar Cohen investigates. [November 26th, 2017]

You can access the audio above or use the player below. (34.6 MB) © ABC Background Briefing;

Or download the mp3 file here.

 

NB: Transcripts are made available at ABC Background Briefing past programmes shortly after the programme airs.

Advertisements

Debunking Anti-Vaxxers

Just over a couple of months ago the video Debunking Anti-Vaxxers was published by Toronto based AsapSCIENCE.

There’s a lot of very helpful information packed into less than seven and a half minutes, and it’s particularly worth visiting the YouTube page for a very comprehensive list of “further reading references”.

You can follow @mitchellmoffitt and @Whalewatchmeplz on Twitter and on Instagram here and here, respectively. There are also links to AsapSCIENCE on Instagram, Facebook, Twitter and Tumblr.

 

I was also interested to come across Bill and Melinda Gates’ 2018 Annual Letter. It’s entitled The 10 Toughest Questions We Get. The questions are answered with graphs, videos and margin notes.

They are;

  1. Why don’t you give more in the United States?
  2. What do you have to show for the billions you’ve spent on U.S. education?
  3. Why don’t you give money to fight climate change?
  4. Are you imposing your values on other cultures?
  5. Does saving kids’ lives lead to overpopulation?
  6. How are President Trump’s policies affecting your foundation’s work?
  7. Why do you work with corporations?
  8. Is it fair that you have so much influence?
  9. What happens when the two of you disagree?
  10. Why are you really giving your money away—what’s in it for you?

Seven Ways to Identify Pseudoscience

Original seven ways – © Relatively Interesting

  • The use of psychobabble – words that sound scientific and professional but are used incorrectly, or in a misleading manner;

Self-help books, folk and pop psychology, and motivational seminars often use psychobabble.  Deepak Chopra is a name that comes to mind at present. Nothing more than a fraud according to Professor Jerry Coyne, one may delight in the Wisdom of Chopra which is a Twitter stream made up of seeming quotes that are randomly generated by words that can be found in his genuine Twitter stream. If anybody breathes prescient life into the words of the late Carl Sagan it is the scoundrel and intellectual mobster Deepak Chopra.

Sagan proffered;

I worry that, especially as the Millennium edges nearer, pseudo-science and superstition will seem year by year more tempting, the siren song of unreason more sonorous and attractive.

  • A substantial reliance on anecdotal evidence;

Without a doubt the alternatives to medicine behemoth would be lost without dramatic tales of self-limiting illnesses merely running their course, or completely false or hugely exaggerated stories of serious, disabling or terminal disease executing an about face due to the power of some wonderful concoction. The frustrating hurdle here for those who promote reason is that almost all work undertaken to convince the patient occurs in their own mind. Scam artists from peddlers of herbs to chiropractors, Baptist religions and indeed even the Catholic Church are swift to take credit if they have been involved.

  • Extraordinary claims in the absence of extraordinary evidence;

From 9/11 being an inside job to images of the apparent exhumation of giant skeletons to alien autopsy videos and shaky vision of UFOs drifting across a grainy background it seems all these and other extraordinary claims have one thing in common. A powerful need to believe in their truth by those that ensure certain – in fact sometimes many – conspiracy theories indeed exist. Now thanks to Netflix we can wander through a range of delightful titles that offer everything from reasonable special effects to WW2 era reports and “experts” convinced our governments expect us to believe the laws of physics have been broken.

  • Claims which cannot be proven false;

Insisting oneself or perhaps a number of people in the world have communicated telepathically at infrequent and random intervals with aliens from a distant star is impossible to disprove on face value. The claimant can continue to insist he/she is unaware of who the other telepathic human recipients are, or when he/she will receive or has received a communication. The communication may be quite benign such as, “Happy Birthday Deepak”.

Ideally the burden of proof should be placed on the party making the claim.

  • Claims that counter established scientific fact;

Often going hand in hand with claims that rely on anecdotal evidence are those that defy scientific fact. Homeopathy stands atop the podium in this regard. Not only is it absolutely certain to not work but it’s adherents may insist on relaying impossible tales – often knowing they are outright lies – to besmear evidence based medicine and promote junk, bogus cures. For example pertussis (or Whooping Cough) is sometimes referred to as “the 100 day cough”. Prominent Australian antivaccinationist Meryl Dorey claimed on national TV both her vaccinated and unvaccinated children “got it”. She treated it homeopathically and “none of us were sick for more than two weeks and it was nothing worse than a bad cough”.

Countering established fact may be said of an enormous number of claims made about pseudoscientific “cures” for many ailments. Some treat energy meridians or “chakras” that don’t actually exist. These involve peddling herbs, acupuncture, acupressure, chiropractic, osteopathy, chanting, cupping, aligning activities with moon cycles, astrology and more.

Without a doubt denial of anthropogenic climate change should be mentioned here and we might again reflect upon to Carl Sagan’s worrying prediction.

  • Absence of adequate peer review;

In 2015 antivaccinationist and science fraud Judy Wilyman, under the auspicies of antivaccinationist and conspiracy sympathiser Dr. Brian Martin, finished her PhD at the University of Wollongong. The controversy surrounding inadequate peer review between 2012 to 2016 and indeed until today is a function of the copious inaccuracies in her thesis. Entitled “A critical analysis of the Australian Government’s rationale for its vaccination policy”, it was an immature an inaccurate antivaccination conspiracy rant. The fact that it was accepted, and indeed accepted with it’s discredited bibliography, indicates a clear absence of adequate peer review.

Tragically this eventuality has emboldened Wilyman to demand respect from academics and to level outrageous personal claims at her critics, rather than attempt to publish respectable material.

  • Claims that are repeated despite being refuted;

Whilst a great deal of the above intellectual repugnance deserves a slice of this pie, the authors at Relatively Interesting have populated it with the anti-vaccination obsession with the globally damaging claim that vaccines cause autism. Originally at a 1998 media conference designed to reassure parents, head author of the now rejected paper Andrew Wakefield proffered the baseless claim that rather than use the MMR trivalent vaccine, parents should consider choosing single shot vaccines. The “vaccines cause autism” claim has not only been shown to be false and cannot be replicated, but it is now well established that Wakefield acted with the sole aim of making tens and probably hundreds of millions of pounds via his plan to establish immuno-analysis laboratories for the new condition he was calling autistic enterocolitis. He also held patents for single shot measles, mumps and rubella vaccines.

A five member General Medical Council panel found Wakefield guilty of over 30 charges including 12 of causing children to endure “clinically unjustified” invasive testing procedures, buying blood at children’s birthday parties and managing four counts of dishonesty. Then, his “continued lack of insight” into his conduct, and consequences thereof, meant that only “total erasure” from the medical register was warranted. Today on the back of countless refutations of Wakefields claims he now pushes the fraudumentary Vaxxed full of false information and complete with the tampered audio of phone conversations.

 

Regrettably today more than in recent years we can benefit from keeping an eye out for these seven markers of pseudo-science.

The fight against anti-vaxxers continues despite Andrew Wakefield’s ongoing deceit

In early August last year the Australian Vaccination-skeptics Network held one of many Australian screenings of the fraudulent, debunked anti-vaccine film Vaxxed at Hawthorn town hall in Melbourne Victoria. The director of this nonsense is disgraced former gastroenterologist and persistent enemy of public vaccination, Andrew Wakefield.

At this event the AVN hosted a rogue Melbourne GP who, using bogus claims, was helping parents circumvent No Jab No Play legislation. With video of the GP published online, the outcome was immediate revelation of his identity. Three weeks later Dr. John Piesse faced suspension by the Australian Health Practitioner Regulation Agency (AHPRA). At that time it was reported he “vowed” to continue placing innocent children and the community at risk until he was indeed suspended. Not long after he agreed to stop practising while AHPRA investigated his conduct.

By mid September he had his licence suspended. The ABC reported;

A Melbourne doctor who has been under investigation for his anti-vaccination stance has had his licence to practise suspended.

Dr John Piesse’s practice in Mitcham was raided by the Australian Health Practitioner Regulation Agency (AHPRA) and police officers last week following allegations he had helped families avoid compulsory childhood vaccinations.

He had agreed to stop practising temporarily while AHPRA investigated the matter.

But the Medical Board of Australia’s Immediate Action Committee met on Thursday and decided to suspend his registration while the investigation into his practice continued.

An excellent and comprehensive summary of Dr. John Piesse may be found at Diluted Thinking.

Because of the danger posed by Piesse and an unknown number of other GP’s who may be engaging in similar conduct, new No Jab No Play laws were recently announced by Victoria’s Minister for Health, The Hon Jill Hennessy MP. [PDF]

The damage done by the anti-vaccination lobby across the developed and developing world continues. Their lies cost lives and quality of life. In addition they promote angst for innocent parents and attack hard working advocates – who may be grieving parents themselves – with relish.

It is now 20 years since Wakefield published his fraudulent paper in The Lancet contending a link between the MMR vaccine, bowel disease and autism. It was ultimately described by The Lancet’s editor-in-chief as “utterly false”. A 2004 investigation by Brian Deer of Britain’s Sunday Times uncovered enormous financial conflicts of interest. Wakefield was exposed as a liar and fraud and struck off the UK medical register. Astonishingly three dozen charges were found proved. Almost all of his fellow authors withdrew their names and support from the fraudulent paper.

With thunderous arrogance Wakefield “rejects” all of the findings against him.

Years of research failed to reproduce or uncover phenomena similar to his claims. Wakefield continues to push his fraud from the USA, profiting now from the global Conspiracy Theory movement, destroying public health and what is left of his callous character as he goes.

One understands Vaxxed is simply his most recent project. If and when more follow, as has been suggested, they too will be debunked.

Recently BBC 4 produced an excellent review of the anti-vaccine movement titled, In the Wake of Wakefield (BBC).

Twenty years ago, in February 1998, one of the most serious public health scandals of the 20th century was born, when researcher, Andrew Wakefield and his co-authors published a paper in the medical journal The Lancet.

  • You can access the audio below, © BBC 4;

Measles makes a slow start to 2018 in Australia

According to the Australian Government’s Department of Health;

Measles is a highly infectious disease caused by the Morbillivirus. The virus is spread from person to person through droplets in the air. Symptoms take between 10 and 14 days to show after infection and include rash, fever, cough, runny nose and inflammation of the eye. Complications of measles include ear, brain and lung infections, which can lead to brain damage and death. Approximately one child in every 1,000 who contracts measles will develop inflammation of the brain (encephalitis). Immunisation rates of up to 95% are required for the sustained control of vaccine preventable diseases, such as measles.

The description above was last updated on March 20th, 2014. As evidenced in the National Notifiable Diseases Surveillance System table below, 2014 was a frightening year for measles infection. The year’s total of 339 was the highest for 16 years and each of the first three months had higher notifications than any other month of the year. Although June and July notifications were only two and four less, respectively.

Numbers of measles notification per State and Territory are tabulated here.

In fact 2014 saw measles outbreaks across the globe. Australia experienced an influx of cases from Asia, Indonesia and the Philippines which resulted in unvaccinated children in Australia being infected according to the Department of Health. There were over 58,000 cases in the Philippines and 110 deaths, reported in February 2015. The USA experienced an outbreak with a similar cause.

The Disease Daily reported in Outbreaks of 2014;

Over the course of the last year, there have been 610 reported cases of measles across twenty states.  The reemergence of measles can be attributed, in part, to increased international travel where infected travelers have imported the disease into the United States. Particularly for 2014, many measles case clusters were traced back to the large ongoing measles outbreak happening in the Philippines. However, those in the United States who have become infected are generally unvaccinated, often by their own volition.

Further highlighting the role the unvaccinated play in sparking measles epidemics, one notes that the CDC also highlighted the role of unvaccinated Amish communities;

2014: The U.S. experienced 23 measles outbreaks in 2014, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio. Many of the cases in the U.S. in 2014 were associated with cases brought in from the Philippines, which experienced a large measles outbreak.

The Public Health Agency of Canada also raised concerns of measles infection and unvaccinated children;

Widespread use of the measles vaccine has dramatically reduced the numbers of cases in Canada over the past 45 years. But the recent outbreak in British Columbia is underscoring how the highly contagious virus can very effectively seek out groups of unprotected children.

With respect to The Netherlands a paper by Woudenberg, et al, entitled Large measles epidemic in the Netherlands, May 2013 to March 2014: changing epidemiology examined two measles epidemics (1999-2000 and 2013-14) that primarily effected orthodox Protestants. In the second epidemic, 27 May 2013 – 12 March 2014, 2,700 cases were reported. Molecular typing of the outbreak strain indicated a sequence indistinguishable from a strain first identified in Wales UK in the second half of 2012: the Taunton sequence.

The first Dutch case was identified with the Taunton sequence in May 2013. By this time 900 identical sequences had been reported from the UK, France, Ireland and the Russian Federation, making a source country difficult to identify. The Netherlands outbreak was indicated as the source of outbreaks in Belgium and Canada and from Canada to the USA. Social ties between orthodox Protestants in the Netherlands and Canada leading to the spread of vaccine-preventable disease such as polio, measles, mumps and rubella to Canada has been previously reported.

Reinforcing the importance of national herd immunity to international control of measles the authors of this study conclude in part;

The number of individuals refraining from vaccination is insufficient to sustain endemic measles transmission in the Netherlands. Nevertheless, this situation does pose a risk to public health in the Netherlands and contributes to the worldwide spread of measles, thus forming an impediment to the elimination of measles in Europe and elsewhere.

Amish communities and orthodox Protestants had a documented impact on reducing measles herd immunity in the USA, and Europe and Canada respectively and this was reflected in the 2014 outbreaks. In Australia whilst small numbers struggle to meet immunisation requirements due to social hardship, the anti-vaccination lobby have for years worked hard to spread disinformation, driving down immunisation rates nationally.

In June 2015 the ABC reported that the “surge” of measles the year before resulted in health authorities calling on Australians to ensure they were up to date with immunisations. If we compare this month’s present number of 4 notifications to the 78 for January 2014 it is clear measles notifications for the first month of this year are just over 5% of January 2014. The figure may rise slightly as further notifications for January reach the NNDSS but at this stage such a low figure is comforting.

Still, there have been warnings specific to measles this year and late last year. Victoria issued a measles health alert (Confirmed measles case in Melbourne) on December 5th 2017. This was a single case acquired overseas and fortunately the national total for December 2017 remains at 2. The alert is now resolved. An identical measles health alert for Melbourne, differing only in where the individual travelled when infectious was issued on January 17th 2018 and remains active.

This was reported in The Age on the same day.

Passengers who flew from Dubai to Melbourne last Thursday have been warned that a fellow passenger has an “extremely infectious” case of the measles.

[…]

Measles has an incubation period of seven to 18 days, so fellow passengers may develop symptoms from Thursday until the end of the month.

As today is the last day of the month this status may change to resolved as of midnight. W.A. Health issued a very similar warning via Twitter on January 11th.

This was reported the same day in Perth Now by Cathy O’Leary.

We have no way of telling what measles notifications will be over the remainder of 2018. September and October last year saw a worrying spike in notifications in Melbourne. However we in Australia can be grateful for No Jab No Pay legislation.

Globally at present measles is proving a problem in developed and developing nations. In the UK the NHS has confirmed well over 100 cases in five regions. The high risk of being unvaccinated and travelling is being stressed to the public. Dr Mary Ramsay, head of immunisation at Public Health England said;

People who have recently travelled, or are planning to travel to Romania, Italy and Germany and have not had two doses of the MMR vaccine are particularly at risk

Countries at risk are evident in this January 12th, 2018 report, Measles in the EU/EEA: current outbreaks, latest data and trends – January 2018. Most cases were unvaccinated or incompletely vaccinated. The report included.

The spread of measles across Europe is due to suboptimal vaccination coverage in many EU/EEA countries: of all measles cases reported during the one-year period 1 December 2016 to 30 November 2017 with known vaccination status, 87% were not vaccinated.

In the first two weeks of January the measles outbreak in the Ukraine has resulted in 1285 cases. Ukraine measles vaccination uptake is regarded as the worst in Europe, being under 50% in recent years according to the Ukraine Health Ministry. It was reported on January 21st that The Acting Health Minister Ulyana Suprun said;

Yesterday it became known about yet another death from measles. This is a child who has not been vaccinated. This is the eighth death case since the start of the outbreak, and this is the tragedy of our society, in which people die from diseases that are prevented by vaccinations […]

In order to achieve the measles elimination goal, the vaccination coverage rates for children targeted by routine vaccination programmes should increase in a number of countries, as the vaccination coverage of the second dose must be at least 95% to interrupt measles circulation and achieve herd immunity.

Presently a tragedy due to neglect, poverty, malnutrition and measles is unfolding in Papua, Indonesia.

AFP reported on January 28th;

Some 800 children have fallen ill and as many as 100 others, mostly toddlers, are feared to have died in what Jakarta called an “extraordinary” outbreak that was first made public this month. […]

When Widodo took office in 2014, he vowed to speed up infrastructure development and services, bolstering hopes for the region, observers said.

“What the government is saying is what we think is important to do (for Papua) is in fact not being done,” said Richard Chauvel, a Papua expert at the University of Melbourne’s Asia Institute. […]

“As measles is easily prevented with a safe and inexpensive vaccine, these deaths should never have happened,” said Freddy Numberi, a former governor of Papua. [He added] that Papua has Indonesia’s lowest life expectancy and highest infant, child and maternal mortality rates.

Without a doubt it is the same pattern across the globe. Measles epidemics will sprout wherever herd immunity is unsuitable. More so it is the unvaccinated who will suffer the consequences of widespread infection, whether in developing or developed nations.

Indeed even with low levels of infection the unvaccinated, with an infection rate of approximately 90%, bear the brunt of infection. Australia’s anti-vaccination lobby has for years pushed fear and disinformation, spreading ignorance and apathy leading directly to low herd immunity and epidemics of vaccine preventable disease.

This has resulted in effective legislative change manifesting as No Jab, No Pay and No Jab, No Play. The policy has been successful in raising vaccination uptake.

According to Immunise Australia;

The disease which requires the highest level of vaccine coverage to achieve herd immunity is measles as it is highly infectious. It is estimated that coverage of 92-94% is required for herd immunity from this virus. For this reason the national aspirational immunisation coverage target has been set at 95%. This target provides sufficient herd immunity to prevent transmission of other vaccine preventable diseases and supports Australia’s contribution to achieving measles elimination in the Western Pacific Region.

Fortunately January 2018 has indicated measles notification the lowest in four years. Whilst measles continues to present challenges around the world, Australia should remain vigilant and ensure we keep ahead of any potential outbreak.