The Lethally Deep Roots of Politicized Medicine (17)

This is the seventeenth in a series of articles covering the ongoing story of Christian physician Dr. Punyamurtula S. Kishore, whose extraordinary addiction medicine practice was torpedoed by the Commonwealth of Massachusetts in September 2011 and whose persecution has continued into the present. The list of earlier articles we’ve been supplying has grown so long (nearly taking up a page in itself) that we may omit it from the end of this article (at least in the print edition). Our serial coverage of this story will soon come to a close as the film project and associated book near completion.

Philosophy professor Dr. Michael Gendre has made the first fifteen articles in this series required reading in his Ethics and Society class. His interest in Dr. Kishore’s case is more than academic, however. He was an eyewitness to how the media in the state of Maine chose to handle Dr. Kishore’s story in a calculated effort to derail his growing influence there (and to thus protect the methadone and Suboxone® industries in that state from a fatal competitive challenge to their hegemony). It became clear to Dr. Gendre that the tactics employed in Maine would also be used to challenge the film, and that a massive deconstruction of those tactics was called for.

We hope to post Dr. Gendre’s work online once it is ready. It demonstrates some clear affinities between Massachusetts journalism and Maine journalism: casual disdain for the truth, an unwillingness to even know the truth, and an embedded bias so deep the resulting “news” articles are models of fragmentation and logical incoherence. If we can color code the positive and negative sections of the article online, you’ll be able to see how the journalist weaves in the negatives to neutralize the positives, even though the negatives have no relation to the positive points they follow. The Frankenstein monster thus stitched together gives the unwary reader the impression the piece is balanced and objective, but a closer look (such as Dr. Gendre has provided) reveals the hidden agenda that’s actually at work.

As it turns out, this kind of suppression (direct and indirect) in respect to addiction medicine is not new. It actually extends back to the dawn of the opiate crisis in the days of the Vietnam War. To understand how we got to where we are now (and to avoid repeating a sordid history), we need to take a crucial step backward to see that our current situation arose when politics (and crony capitalism) first began to contaminate the pharmaceutical industry, setting the deadly course we’ve been sailing ever since. Our guide for this historical narrative is Percy Menzies (M.Pharm.), who had a bird’s eye view of that history, as he explained to me in regard to Dr. Kishore’s work (for those familiar with the previous sixteen articles, note that Vivitrol® is the monthly injected form of naltrexone, a medicine also available as a pill taken either daily or three times a week):

I worked for the pharmaceutical company that developed naltrexone. My job initially was to introduce and train physicians on the use of this radically different medication, developed specifically to protect detoxed heroin addicts from relapsing when they returned home after residential treatment or incarceration. I cannot explain why I was so intrigued by this medication. Never in the history of medicine were two medications (methadone and naltrexone) at the opposite ends of the spectrum offered as treatment. You can guess who won.

I met Dr. Kishore in Boston over twenty years ago and instantly fell in love with him! I have not met another physician in the field so knowledgeable and passionate about helping people. He was that rare person who, like me, was determined to offer patients evidence-based treatments.

I was the associate product director for Revia (naltrexone) when I left the company about sixteen years ago to fulfill my mission. My clinics¹ in the St. Louis area treat in excess of four hundred heroin patients a month and the mainstay of our treatment is Suboxone®, naltrexone, and Vivitrol.

I met Dr. Kishore again in Boston about twelve years ago and he took me to some of his clinics and I spoke to his staff on how we use naltrexone … I am one of the experts on naltrexone and can share the history and politics of this medication. I call it a Greek tragedy!

It is that Greek tragedy that we will now unfold under the guidance of eyewitness Percy Menzies. The perspective this provides will permit us to properly frame the ugly effects that politicized decision keeps making in the realm of medicine. The following sections are garnered from direct discussions between Menzies and myself on March 12, 2017. Direct quotes are indented below.

Those returning Vietnam War vets who were addicted to heroin instilled grave concern in the Nixon administration, which overreacted. If they came back addicted to heroin, they’d surely create an increase in crime! Heroin addiction was considered to be as virulent as viruses that infected fish: it was thought that one returning GI heroin addict would infect fifty other people stateside, turning them into heroin addicts too. Something had to be done.

Nixon’s advisors told him that Dr. Jerome Jaffe, a psychiatrist in Chicago, had great success using methadone. Vincent Dole and Marie Nyswander had done the early studies on methadone but knew its limitations.

What was overlooked was that Dr. Jaffe agreed to bring in methadone because he knew of a new molecule (which later became naltrexone) that would be a huge leap forward for heroin addiction. So, the Nixon administration funded development of a long-term acting methadone (LAAM, in contrast to take-once-a-day methadone) and a long acting oral antagonist (naltrexone). Neither one saw the light of day because both were opposed by the methadone lobby and clinics. LAAM was not lucrative for them and naltrexone was rejected on the grounds that it “blocked the pleasure systems” and was thus suitable only for highly functioning, highly motivated clients like airline pilots and doctors.

Nixon agreed to the creation of the DEA in 1973 and approved methadone in 1974. Methadone was perhaps the only drug to not go through the standard approval process but was rushed through on a presidential order. The approach taken had three tiers: interdiction, treatment, and funding of safer alternative treatments, such as LAAM and naltrexone. To prevent diversion of drugs, methadone had to be ingested daily at a methadone clinic.

In actual fact, only 5 percent of the heroin addicts addicted while in Vietnam continued using heroin at home² (the other 95 percent reconnected with family, etc., and lost interest in the promise of false endorphins). Neither did returning vets have easy access to heroin in the U.S.—it was not accessible here back then.

In other words, the fear-mongering statistics that launched methadone were completely unfounded, but the methadone lobby, undaunted, persisted in pushing Opioid Substitution Therapy (OST) with a twist: only methadone could be used for OST, nothing else. Menzies believes this pushed the treatment of heroin addiction outside the mainstream of medicine.

The tragedy was that Dr. Jaffe was supposed to spearhead introduction of naltrexone, but he was such a strong advocate for methadone that he had little interest in seeing naltrexone move forward. Methadone was introduced in 1974, but when naltrexone was introduced in 1984, it had a black box warning that it caused liver damage: essentially the kiss of death for the drug. Significantly, the only drug in the history of the FDA that ever had its black box warning removed was naltrexone, but that took thirty years to happen! That is indicative of the politics of opiate treatment.

The rush was on to open methadone clinics. The results were disastrous. Many of their clients were barely recovered themselves and yet were asked to work in the clinics. The Illinois plan required that only people in recovery could be hired by the clinics, but that was appealed and found to be discriminatory. Hospitals like Beth Israel jumped in with both feet. At that time, a clinic could be called not-for-profit and still make up to $200,000/year in profit, tax-exempt.

At the outset, the Nixon administration estimated naltrexone would be approved within two or three years allowing for the methadone clinics to be phased out. Menzies elaborates:

Under Nixon, there was already a plan to decommission all methadone clinics. Methadone was intended to be nothing more than a stopgap measure. Back in 1914, the Harrison Act shut down the morphine clinics, which is why methadone maintenance was not seen as a solution at all. So it was a surprise to see the discredited, discarded method (opioid substitution therapy) come back to life. Scientists weren’t prepared for this, but relaxed their objections when reminded that methadone was merely a stopgap medication. Once methadone got its foot in the door, however, the methadone clinics lobbied to oppose naltrexone and guide the mutation of the stopgap measure into a permanent solution.

Then naltrexone was charged with causing cancer in mice, so someone would have to do a study to see if it really did. But all naltrexone studies had been halted, so the required study was for all intents and purposes blocked.

Methadone’s dominance was now safely insulated against naltrexone because nobody was supposed to be conducting studies on the latter. The methadone juggernaut had enough momentum that it could easily weather denunciations appearing later in refereed journals (e.g., “giving methadone to addicts is like giving sterile razors to a suicidal patient”).³ But the Achilles’ heel, the one unshielded point susceptible to attack, was an unexpected result in Westchester County, New York.

The patients being released from prison on a work release program were allowed to go to work on condition they take naltrexone, and the resulting study was a phenomenal success. The Westchester folks had no idea all naltrexone studies had been stopped, and they accumulated a huge amount of data on the drug that proved its long term safety. Nobody outside of Westchester knew they were still using naltrexone, and using it so successfully.

The charge of liver damage was debunked in a similar fashion, but that exoneration took three decades to achieve.⁴ Naltrexone’s early trials had gone poorly⁵ and these cancer and liver damage claims derailed further efforts to develop suitable protocols⁶ for its use. 

Naltrexone was the first drug to be approved under the Orphan Drug Act of 1983. Methadone dominated the field, which was not the intention of the Nixon administration, but the obstacles against naltrexone were formidable. Says Menzies,

We could not get any traction for this drug. Introduction was practically impossible. We were told we would have a very limited market for a very select population. Within three years we had to stop marketing the drug. You couldn’t even give it away as samples.

You cannot treat a complex condition with only one solution. The more options you have, the better the outcomes will be. With any chronic condition or disorder, you need a plethora of medication options, not a single controversial solution.

There was no support for naltrexone whatsoever. Why would you have such hostility toward a medication that was so incredibly effective? Regardless of age, it was 100 percent effective: the heroin could not enter the brain, giving the patient a fighting chance to get well. Methadone allowed the addict to keep abusing heroin, but naltrexone did not.

Menzies noted that even back then, methadone was being falsely compared to insulin. It was held that “you must stay on methadone forever, just like a diabetic must stay on insulin forever.” Dr. Kishore fully debunked this incoherent claim in the sixteenth article in this series. Because that myth still persists, there’s no attempt to wean methadone users off methadone (especially as the dangerous “harm reduction” paradigm became dominant, driving out the “harm avoidance” and “harm elimination” models that promote sobriety).

As reported in an earlier article in this series, a key researcher doing government-funded comparisons between treatments was told to omit naltrexone (Vivitrol®) from the testing matrix. No head-to-head comparisons between it and methadone and Suboxone® were to see the light of day: the scientific study was apparently intended to underscore this by way of a blackout. 

In the meantime, current dogma is that “OST is the most effective treatment,” which fundamentally means methadone. Upstart drug Suboxone® (buprenorphine) has made a strong play, but its problems have been documented here beginning with the very first article in this series. As Menzies said in jest,

There is more Suboxone® on the streets than in pharmacies. It’s an addicting drug that can be diverted and abused. The CARE Act raised the limit of patients a physician can prescribe buprenorphine for from 100 to 270, but substitution treatment becomes less effective when the supply of opiates isn’t cut off. You simply have more opiates flooding the marketplace. Even The Washington Post admits that patients using Suboxone® continue to use opiates. It isn’t stopping opiate abuse.

Enter the new acronym, MAT, discussed in the previous article. MAT (Medically Assisted Treatment) is, to quote Menzies, “a transparent figleaf.”

MAT is a term coined to remove the word “methadone” (which had become controversial) and raise the banner of a “gold standard” in addiction treatment, which was to be methadone and only methadone. This was marketing hype, enforced by hostility toward competing medications.

Why does MAT not include the other four FDA-approved medications used to fight addiction? But we prevailed on the definition, and MAT now includes all approved medications, including naltrexone. But for all practical purposes, the other three medications are hardly used. By default, MAT has come to mean methadone and Suboxone®.

By 1994 or 1995, addiction had ratcheted up to a big problem. Why did MAT not have an impact in stemming the problem? Menzies sees a key mismatch that makes no sense:

Look at the progress we have made against AIDS. Why aren’t we having these kinds of advances with respect to addiction? After all, the federal government has no hesitation in spending tens of billions of dollars.

More and more states are saying “social detox” is not allowed: you must use medical detox. After detox, MAT enters in as “the gold standard,” essentially meaning methadone. Nobody considers asking Cicero’s question, Cui bono (“Who benefits”)? Nobody thinks to follow the money or question motives or agendas. As a result of dropping naltrexone from the debate, we end up with the two opposing poles fighting a battle that Menzies calls Pharmacophobia (the Alcoholics Anonymous approach) versus Pharmacohegemony (the methadone/buprenorphine approach). Consequently,

Naltrexone is a victim of the ideological battles between the AA groups and the MAT groups that primarily promote OST.

How’s that battle going? America is consuming ninety metric tons of hydrocodone a year, and now police departments are being given Narcan (naloxone, not to be confused with naltrexone) to “save” people who have overdosed. That the hype over Narcan is phony has been documented in earlier articles in this series. Menzies has his own views on it:

This is absolutely crazy: they say they are going to solve the problem by distributing Narcan syringes and flooding the country with buprenorphine.

Narcan is a forty-year-old drug, for crying out loud! One of my jobs was to train physicians to use Narcan, and there was no use for it—it was only used for emergencies to reverse the effects of opiates/anesthesia after surgery had ended. Now the price for Narcan has gone up to $2,500 to $4,000 a shot. Narcan has a two-year expiration date, so the supplies have to be replenished. 

Heart attack? Good to have a portable defibrillator nearby. But with opiate addiction, you don’t know where the patient is going to overdose. Could be a bathroom he’s hiding in.⁸ So the strategy cannot be “let’s give out Narcan and switch to buprenorphine.” This simply won’t work. 

Hospitals have no interest in treating addiction, say Menzies and Dr. Kishore, and physicians simply don’t see it as a big revenue generator for themselves. The prevailing attitude⁹ appears to be, “Let somebody else take care of addiction, someone outside the realm of medicine. These are social lepers anyway, let’s throw them out into the wilderness.” 

The most troubling recent development is an incipient trend to treat prescription of naltrexone/Vivitrol® as a human rights violation, on the grounds that it is a fundamental human right to be high on a psychotropic drug, and these drugs deprive people of that right, of the freedom to abuse addictive substances. Ideas like this have apparently been advanced by the George Soros-funded Drug Policy Alliance (a U.S. nonprofit) and have reached beyond the U.S.

It is regarded as unethical to give a drug like naltrexone because it takes away somebody’s freedom to take heroin. But Menzies points out that naltrexone is a treatment option, and being that it is option, it is inherently ethical to offer it. But the opposition says No, it is not ethical to offer naltrexone to treat drug addiction. Menzies explains further:

Nal-trexone restores your freedom; it doesn’t deprive you of it. This is particularly exasperating to me because the United Nations is just promoting methadone and buprenorphine. These guys at the UN are not in the trenches.

When it comes to treating drug addiction, Russia only allows naltrexone, not methadone or buprenorphine. (This apparently dovetails with the “violation of fundamental human rights” motif again.) The largest study on naltrexone ever done was in Russia, and Percy Menzies assisted on it (and the drug’s enemies denigrated the study and, while they were at it, the Russians too). Special interest groups control the narrative and continue to insist that “naltrexone doesn’t work.”¹⁰

When the U.S. Surgeon General issued his report on drug addiction, he sent a letter to every single physician in the country laying out three treatment options: methadone, Suboxone®, and naltrexone. But voices have raised strenuous opposition to the Surgeon General’s actions, holding that he should not have said there are three medications¹¹ because naltrexone does not work and should not have been publicly acknowledged by the Surgeon General.¹²

In the clinics that Menzies operates in St. Louis, naltrexone is given in pill form. Patients take two on Monday, two on Wednesday, and two on Friday; this regimen keeps the patient in continual contact with the clinic. Such contact is a natural outcome of the dosing strategy in St. Louis, whereas in Dr. Kishore’s case (where naltrexone is administered in the form of a monthly shot under the name Vivitrol®) the counseling/primary care component was intuited first, with urine testing consequently proving its clinical value within a sobriety maintenance context (see the earlier articles in this series for how this new but medically legitimate strategy was used by the ignorant against Dr. Kishore to destroy his fifty-two clinical centers).

Menzies, intimately familiar with the brutal suppression of naltrexone, sheds further light on developments he’s witnessed in regard to it. Addictive substances can impose the equivalent of a Stockholm Syndrome on the victim, who befriends his enemy and distrusts his true friends:

Naltrexone works, but the patients’ brains have been hijacked by the abused opiates so they see naltrexone as a form of punishment.

The regularity of the clinic visits, in conjunction with a string of teachable moments, permits continual interaction between patients and clinicians (who reinforce the positive and monitor compliance with court orders). The migration from the pill to the monthly Vivitrol^® shot has emerged as a significant change in St. Louis:

Everyone wants the shot now, because word has spread that it’s amazing. We only use the pills for those without insurance, or when law enforcement requests naltrexone pills to keep costs down.

Vivitrol is used more and more in the correctional system, as if it is a punitive drug, but it’s not punitive, it liberates you, it gives you your freedom back.

Menzies explains that the “deprivation effect” or “conditioned abstinence” is the primary cause of relapse. Like Dr. Kishore, successful treatment requires “extinguishing the conditioning,” namely, cue extinction. How well you extinguish them determines how successful the return to sobriety will be.

An implicit endorsement from the insurance industry is becoming harder for the naysayers to explain away, as Menzies points out to patients considering the monthly Vivitrol^® shot:

We always criticize the insurance companies for being cheap. Why then would most insurance companies prefer the $1,200 shot over the $2 pill? Because the shot has fewer relapses, fewer readmits to hospitals, much greater success, and is known to be life-saving. It saves them money to get you well. You should be excited the insurance company is giving that expensive shot to you. It tells you something.

Missouri is now one of the leading states using Vivitrol^®, and the number one state in the nation using the naltrexone pills. Had Dr. Kishore’s clinics not been torpedoed, Massachusetts may well have been in that position, but cobelligerent Menzies arrived there first because he hadn’t been brutally put down by his state government.

In the beginning, naltrexone was not a big money maker, and though eight to ten different companies now manufacture it as a generic, there is no promotion for it. Why? Because there’s no money in it when it’s available for as low as eighty cents per tablet.

Dr. Michael Gendre joined Dr. Kishore to witness the Menzies treatment centers in operation on March 10, 2017. Dr. Gendre was impressed with the results he saw with naltrexone treatment, facetiously wondering out loud if anyone had offered to include it in the water supplies of some cities. The more that shrewd observers take in the magnitude of the situation, he noted, the more the mystery deepens. It is an open question why the authorities are saying yes to Narcan but no to naltrexone. Why the visceral hostility toward naltrexone? Why are only a handful of physicians strong supporters of naltrexone/Vivitrol^®? Menzies drove the point home for his visitors:

We could reduce the jail population by 60 percent if we used this system. You wouldn’t be building new jails, you’d be shutting them down. We aren’t handling this properly.

The politics of alcohol and drug treatment is worse than the disease. The disease can be treated, but the politics is beyond help. It is so deeply entrenched, and the victims of the politics are the patients.

Menzies believes it’s unconscionable that 28 million people are affected with alcohol and drug addiction but only five medicines are available for them, and only 10 percent receive any medical treatment, “the other 90 percent being stuck up the creek without a paddle. They just have to use willpower. They’re stuck with where they are.”

Methadone clinics are a symbol of the government’s indifference to its people. They are not chummy places, not symbols of compassion. A smile or a hug is far more meaningful than “here, drink this, goodbye.” The choice is between methadone clinics or humane treatment.

Unless we treat addiction as a public health issue, not a criminal justice issue, we will fail. We need to give these people a cash incentive. Their source of income is selling their bodies or becoming low-level dealers. But give me a program that provides me $5 per patient per day and I can create wonders in the city.

The dominant programs are often promoted by “addiction experts” whose credentials appear to be nothing more than “I’m in recovery myself.” Among these is Michael Botticelli, the former national figure who features quite prominently in the earlier articles in this series.

On March 22, 2017, The Boston Globe announced Botticelli’s return to Massachusetts saying “the nation’s former drug czar is bringing his expertise back to Massachusetts.”  This is truly bad, bad news for Massachusetts. There as elsewhere, all the money is going to supporting the worst solutions, which are propped up by the most egregious fake news imaginable, with roots extending back into the 1970s. Menzies is driven to ask,

Where are the philanthropists? Gates? Clintons? What are they doing? They should be coming out of the woodwork, like they do for AIDS, malaria, etc., shouldn’t they? So they have needle exchange programs and want drugs legalized instead.

I would love to work with one foundation. Give me $50/month/patient plus cost of medication and I can change the world, just like Dr. Kishore was changing outcomes in Massachusetts before he was unthinkingly cashiered.

There are surely differences between the Menzies clinics and Dr. Kishore’s approach, but it’s the factors they have in common that made them successful. 

The blackout against naltrexone and Vivitrol^® has been so successful that Dr. Kishore’s successes have been wiped out in the resulting memory war. As Dr. Kishore pointed out concerning a November 2016 news story,¹⁴

They had two patients—just two!—who “completed” Vivitrol^® treatment and they are crowing about the “experiment” being a success! We had 3,300 patients on Vivitrol^® on any given day at my PMAI clinics in Massachusetts, until Martha Coakley cruelly closed our practices in September 2011.

Nobody remembered the original intention behind methadone’s approval either: that it was to be a temporary stopgap and that naltrexone was to be quickly approved in tandem with it (and not stonewalled for decades to block its introduction). What you don’t know can hurt you.

This, in part, answers the question, Why did Dr. Michael Gendre get involved in the Kishore case and spend so much energy dissecting the payload that a Maine journalist had concocted to block Dr. Kishore’s success from getting off the ground there? The answer is that false narratives (legal, medical, political) have been crafted with incredible care to propel a targeted result to its goal. In itself, each narrative has considerable power to sway the unwary and fearful. As a package deal, they’re formidable enough to need strong medicine to correct, such as the analysis Dr. Gendre has been preparing.

There was one other roadblock on the path to the success of that deadly juggernaut: somewhere in the American psyche there were remnants of Biblical morality sufficient to uphold the notion that sobriety was morally invaluable. The power of this peculiar autopilot¹⁵ to undermine the harm reduction narrative was not to be underestimated by the enemies of sobriety. They have the same answer for this as they have for every other element of Biblical morality that once framed our culture: “Let us break their bands asunder, and cast away their cords from us” (Psalm 2:3). How is this done? By normalizing everything once regarded as abnormal, immoral, perverse, and morally wrong. Moral inversion is the new game in town and has been shaping headlines and standards for decades if not millennia (cf. Isaiah 5:20).

What is now being normalized? Heroin addiction. We’re not talking about removing stigma (in which this moral reversal merely gets its foot in the door) but the wholescale rejection of sobriety and the embrace of keeping heroin addicts happily supplied with “safe” heroin. This is the new normal, the new way that the image of God in man is to be defaced in keeping with the shifting values of postmodernism. Being high on an opiate is being declared a fundamental human right, and sobriety is not only optional, it can assert no ethical superiority or moral claim over anyone ever again.

The continual moving of our moral goalposts can no longer be a matter of indifference. It has now forced upon us an utterly deadly situation. “See, I have set before thee this day life and good, and death and evil” said Moses (Deut. 30:15). He therefore counseled them, “therefore choose life, that both thou and thy seed shall live” (v. 19).

In the matter of drug addiction, counsel such as “choose life” is being rendered obsolete, and if some have their way, will be outlawed to protect the new fundamental human right of choosing a living death instead, something which you will be required to regard as normal. To uphold sobriety, or any other aspect of Biblical morality, will be abnormal and, in time, a microaggression to be decisively sanctioned. If we don’t dig our way out of the memory hole (such as the one documented herein) we will be in no position to send forth a light into the growing darkness: the hole will have become too deep.

1. Assisted Recovery Centers of America, LLC. See http://www.arcamidwest.com

2. Jerome Jaffe enlisted a St. Louis, Missouri psychiatrist, one Dr. Lee Robins, to conduct the study that resulted in that 5 percent determination.

3. Dr. Matt Dumont made this observation concerning Dr. Jaffe’s 1970s push to promote methadone in Addiction (1999) 94(1), 13-30.

4. The liver damage that was discovered was reversible by simply stopping use of naltrexone (it was a high dose of it that was hepatotoxic: six times the actual dose). At 50 mg/day it was very safe, but at 300 mg/day it could cause reversible liver disease. Percy Menzies’s testimony was part of the process of reversing the black box warning—he showed that over 6,000 patients had been taking naltrexone and not one showed any elevated liver enzymes.

5. One expert reviewer of this article noted that “the early clinical trials of oral naltrexone with middle class clients showed a high relapse rate because of non-compliance. The explanation was that it would work only with the most motivated patients. In those days, there was no awareness of the iatrogenic addiction population, even though it existed and was being treated in private psychiatric clinics.” Indeed, this expert didn’t see any promise in naltrexone until after observing Dr. Kishore’s successes with Vivitrol^®.

6. Critics of naltrexone claim it only works when “psychosocial” factors (e.g., counseling, etc.) are in play, and that if you use psychosocial treatment the naltrexone doesn’t improve results: it’s essentially a worthless placebo. But Dr. Kishore’s work turned this erroneous claim on its head because adding Vivitrol® to his existing model improved outcomes from 37 percent to 50-60 percent success rates after one year of treatment as measured with a robust testing regimen.

7. Granted, the term “Orwellian” is overused, so we risk being called lazy and unimaginative for deploying it in our subhead. The subversion of language at the heart of MAT and its intended purposes fits Orwell’s definitions too well for us to abstain from appealing to his insights here.

8. This circumstance is a factor in the documentary film about the destruction of Dr. Kishore’s clinics in Massachusetts.

9. https://www.statnews.com/2016/...

10. One of the more toxic attacks on naltrexone comes from the harm reduction contingent, such as found here: http://theinfluence.org/pushin...

The ways in which this screed turns a blind eye to Dr. Kishore’s quarter-million patients and the successes Percy Menzies has with his clinics (which are quickly dismissed and discredited to fit the narrative) are legion. The critic conflates the primary care/counseling component and abstinence with naltrexone’s effects, not grasping that it is but part of the toolkit for Dr. Kishore. This sleight of hand lets him declare naltrexone to have either no effect, or harmful effects, by denying all connection to measured successes. That the solution preferred by such “harm reducers” includes use of clinical heroin (advocated in this article) is no surprise, as sobriety is under direct attack in such pieces.

11. The comments of Maia Szalavitz are representative in this regard: “Another problem that results from vagueness in the [Surgeon General’s] report is its use of the term “medication assisted treatment” (MAT) to refer to all three medications currently approved for the treatment of opioid addiction. The report states: ‘MAT is a highly effective treatment option for individuals with alcohol and opioid use disorders. Studies have repeatedly demonstrated the efficacy of MAT at reducing illicit drug use and overdose deaths improving retention in treatment and reducing HIV transmission.’ This, however, is true of only two of the medications, methadone and buprenorphine. There is no data suggesting that that the third, naltrexone, reduces overdose death rates (the oral or implanted forms were associated with an eight times greater risk of death in Australian research compared to deaths following methadone; there’s not enough research to know if the injectable long-acting version could have similar problems). Only long-term use of methadone or buprenorphine is linked with saving lives; this data should have been highlighted and these medications advocated as superior care.”

Those who’ve read the previous sixteen articles in this series know that such long term studies as Szalavitz insists must exist once did, but were effectively destroyed in Massachusetts with the majority of those medical records in storage having been shredded. The two remaining containers of documents are at risk of deterioration and the expense of paying the storage rental fees exceeds the meager income from Social Security that Dr. Kishore receives (and even those modest proceeds have a 15 percent garnishment imposed on them). Further, not one single patient died while under Dr. Kishore’s care, giving the lie to this critic’s tendentious citation of Australian death statistics in a program totally unlike the one Dr. Kishore had painstaking developed.

For the entire article posted by Maia Szalavitz, see https://www.theguardian.com/co...

12. https://www.psychologytoday.com/blog/addiction-in-society/201703/the-solution-the-opioid-crisis. Notice the complaint that naltrexone isn’t sufficient by itself (because it is part of a complex recovery regimen to overcome the obstacles to sobriety in the whole person). As demonstrated at the outset of this series, the dominant methods reflect the indifference of the government to the addict and a refusal to look at hard clinical proof such as secured by Dr. Kishore in his clinics.

13. https://www.bostonglobe.com/bu...

14. http://www.fosters.com/news/20...

15. Some have argued that this represents residual spiritual capital from the circumstance that “the work of the law is in their hearts,” Rom. 2:15