By Martin G. Selbrede
This is the eleventh in a series of articles about addiction treatment pioneer Dr. Punyamurtula S. Kishore and his battles with the commonwealth of Massachusetts. The grinding power of the state’s machinery shuttered this Christian doctor’s fifty-two clinics in late 2011, casting his patients back on inferior (and statistically death-increasing) treatments. Rather than export Dr. Kishore’s superior treatments, Massachusetts effectively crushed those results and exported the miserable status quo treatments in the person of Michael Botticelli, acting Drug Czar for the United States of America. Now all Americans are being afflicted with Big Pharma snake oil.
Again, space forbids repeating the story developed in the first ten articles in this series, and the reader new to this story is urged to catch up before reading this (see links below to the previous articles in this series). Once you grasp Dr. Kishore’s achievement with the 250,000 patients that have passed through his clinics (achieving success rates 7.5 to 30 times better than the existing treatment programs, based on hard testing data, viz., actual clinical results), you will better understand the disaster that Massachusetts continues to inflict upon its own people, a disaster it has exported to the federal level to spread the same damage nationwide.
In passing, we must note that hardly any projected dates concerning Dr. Kishore’s journey through incarceration have actually been honored by the authorities. The December 10, 2015, projected release date may be just as burdened with frustrating delays as all earlier milestones have been. But for those following the personal side of this story, December 10 may prove to be what it is advertised to be. We will pick up that trail in the twelfth article once the dust settles. Our concern in this eleventh article, however, will be upon the bigger picture, the drug addiction hurricane swirling around Dr. Kishore, who continues to observe this national crisis from the eye of the storm.
Post-Kishore Massachusetts: climbing death rates
During the two years in which this story has unfolded, mounting evidence has proven two irrefutable facts.
(1) Prior to the state destroying Dr. Kishore’s fifty-two clinics, the death rates from opioid usage were neither growing nor static, they were dropping according to official state documents. From 2006 to 2010, the deaths had actually dropped by 15 percent, most of the drop occurring in the communities where Dr. Kishore’s clinics were located. His program was graduating people from addiction to sobriety. Men and women got their lives back and re-entered society as productive individuals, many even spiritually transformed as a result. The numbers tell the story: 50 percent to 60 percent of his incoming patients were still sober after one year under his treatment program, compared to 1 percent to 5 percent for all other (status quo) programs run by every other “treatment” center.
(2) When his program was shut down and the clinical evidence from his 250,000 patients subjected to an implicit media blackout, death no longer considered taking a holiday in Massachusetts: death started working overtime and expanding his fatal reach, especially in towns where Dr. Kishore’s clinics had been shut. Cui bono (who benefits) from this? Big Pharma. In the meantime, dead men tell no tales … unless someone undertakes to tell their story for them.
Scientific American reported that between the year 2000 and 2013, heroin overdose deaths have nearly quadrupled. Since at least 2013, deaths from drug overdoses nationwide have exceeded car crash deaths, and have also exceeded firearms deaths. The crisis is real. 60 Minutes put a human face on the spread of the plague in America’s heartland. A Nobel-prize winning economist collaborated on a study of CDC data showing the big killers for a major Middle America demographic aren’t heart disease and diabetes, but substance abuse and its corollaries. The Wall Street Journal cited a New Hampshire poll indicating that citizens rank drug deaths as more important than jobs and the economy as a campaign issue for Presidential candidates to address.
Propaganda you can take to the morgue
In an interview with Botticelli published November 13, 2015, John Lavitt says the nation’s Drug Czar (who prefers to be called the Recovery Czar) “has helped advance and transform the drug policies of the nation in light of healthcare reform and a new emphasis on evidence-based treatment options.” Then why was the massive evidence supporting Dr. Kishore’s achievement (extolled elsewhere by experts in the field) completely omitted in Botticelli’s “transformation” of national policy?
Lavitt further says that Botticelli “has been an active proponent of innovations in prevention, criminal justice, treatment, and recovery.” But we’ve rehearsed evidence in this series pinpointing Botticelli as an active opponent of innovations in treatment, specifically, Dr. Kishore’s achievement in Massachusetts. While Botticelli headed up state drug policy for the state, he reportedly discredited the doctor to the media by acting as an unnamed news source.
Michael Botticelli is no slouch at playing the blame game. Dr. Kishore has collated thirteen different examples of the czar’s finger-pointing, a list which is stunning in how it underscores the shift of blame away from the czar’s catastrophic policies. The czar seems to have adopted the notion that the best defense is a blistering offense, and nothing diverts attention like crisis mongering.
The governor wisely bolts … but to where?
Massachusetts governor Charlie Baker made clear that he doesn’t want to preside over 3,500 opioid deaths a year, calling for some kind of disruptive technology to change the playing field: “This requires disruption, disruption.” At the time the governor made these announcements, the innovator behind the only clinically proven disruptive treatment for drug addiction was being paid three dollars a day to sweep the streets of Boston alongside other prisoners.
But any change governor Baker makes amounts to a vote of no confidence in what Michael Botticelli left behind in Massachusetts; and Botticelli has been willing to publicly oppose Baker’s proposals. There may be more to this than merely a kneejerk reaction: one of Baker’s proposals involves letting hospitals “hold substance-abusing patients against their will for up to 3 days.” Why should this be significant? Because Baker would be vindicating Dr. Kishore on the very matter the board of medicine condemned him for (putting the safety of his patients first). Such a move stands to reopen a case the authorities want to see forever closed.
The spreading flame
Massachusetts statistics are in a state of flux, with death rates being revised upward and the state’s per capita federal Medicaid costs the highest in the nation (with the least to show for it). Even earlier reports (since revised upward) are clear that the policies in place in Massachusetts have failed, tarnishing Botticelli’s “legacy,” although President Obama doubled-down on his commitment to such failed treatment programs for the nation at large. Other New England states are seeing similar problems, and so is Pennsylvania. Dr. Kishore finds Maine’s governor to be moving in a positive direction in the face of headlines such as “Heroin killing more Mainers than ever.” Rhode Island is unknowingly following at least one precedent established by Dr. Kishore’s clinics: focusing attention on the geographic areas worst affected by opioid abuse. Status quo treatments dominate the rest of the Rhode Island program, unfortunately: bad solutions applied in the right places will never lead to success. Although Rhode Island is ahead of Massachusetts in geomapping, the results will remain grim.
The deadliest blackout
Consider not only the 95 percent to 99 percent one-year recidivism rate of today’s programs (which have their own concomitant death tolls) but also the death rate inside today’s detox programs. Even foreign journalists are aware of the American problem and report it with embarrassing clarity. Because these deaths occur within accepted treatment programs, they’re overlooked.
Compare these records to Dr. Kishore’s clinics: of the 250,000 people that have passed through his treatment centers, not a single one died while under the doctor’s care. Not one, despite the strident false accusation that Dr. Kishore is a killer because he doesn’t prescribe methadone, etc. Here then is another facet of Dr. Kishore’s success that must also be suppressed and struck from the public record. How best to protect programs that kill than by burying evidence of the one program that didn’t? When state officials speak of “a problem that seems to be growing by the day with no real solution in sight,” that’s because the elusive real solution has been buried as far out of sight as Jimmy Hoffa’s body.
There is at least one serious attempt to launch a treatment program that, while unnecessarily reinventing the wheel that Dr. Kishore had been perfecting, is at least pointed in the right direction by leveraging primary care medicine. These innovative clinics are located in Baltimore and have broken away from the pack, bolting in a different direction. If they follow the data and refuse input from Botticelli, they may one day arrive at Dr. Kishore’s level of success. How tragic that they have to start from scratch because the true gold standard in addiction treatment developed in Massachusetts has suffered a total media blackout. This blackout is malicious in two ways: malicious against Dr. Kishore in personal terms, and malicious against those who are even now dying as a result of the blackout. The mounting death toll is a tragedy that not only Michael Botticelli must answer for, or Martha Coakley, but also the key enabler for these rising mortality rates: the Boston Globe. Pay no attention to their front-page handwringing: there is not one iota of sincerity in any of it.
What about doctors who abuse drugs?
In terms of public health, no other program has been as successful as Dr. Kishore’s Massachusetts Model with its two-pronged focus on sobriety maintenance and sobriety enhancement. Prior to the program’s destruction, it was more than three-quarters of the way to achieving the kind of success rates hitherto only available to doctors who were being treated for substance abuse.
Treatment programs for doctors are nothing like programs available for you and me. In 2009 the Journal for Substance Abuse Treatment reported success rates for doctor treatment programs where 78% still tested clean after five years and 71 percent were still employed after the same period of time. Dr. Kishore’s model, using a fraction of resources, brought the kind of care only known to afflicted doctors into the lives of regular people. For as it turns out, when physicians become addicted, they don’t enter methadone treatment programs. Like congressmen who don’t participate in Social Security or Obamacare, doctors know exactly what they’re doing.
Bearing the expense of substance abuse
For there are societal costs to this crisis, and some researchers have gone so far as to quantify them. A study published in March 2011 calculated the national cost for opioid use in 2007 to be $55.7 billion, a number the researchers asserted would rise. A portion of this money is funneled into failed treatment programs to prop them up and capitalize Big Pharma.
When the societal costs increase, and alternatives to methadone and Suboxone® are kept at bay, more capital is funneled into Big Pharma’s coffers. If you believe clinical studies aren’t tainted by the influence of pharmaceutical companies, Scientific American has proven otherwise, uncovering “hidden conflicts of interest and financial ties to corporate drugmakers.”
The first 10 articles in this series at Chalcedon
See graph on page five of the Recommendations of the Governor’s Opioid Working Group, showing that prior to the Kishore takedown, the highest annual death rate occurred in 2006 with 615 deaths, dropping to 526 deaths in 2010. The clinics were destroyed in September of 2011 to prevent further reduction in deaths, and even then the death rate by year’s end was 603, still below the rate for 2006 and 2007 despite the clinics running only nine months out of twelve. Beginning in 2012, the graph shows Massachusetts opioid death rates skyrocketing as there was nothing in place anymore to prevent it. You will find the official government documentation of these facts here: http://www.mass.gov/eohhs/docs/dph/stop-addiction/recommendations-of-the-governors-opioid-working-group.pdf
Discussed in early articles in this series. The charge was made that Dr. Kishore lacked certification in addiction medicine. What was meant was that he didn’t have approval to prescribe methadone. This claim is wrong on multiple levels, but most significantly in this way: Dr. Kishore’s treatment doesn’t even use methadone – it is a non-narcotic method that yields vastly superior results to methadone maintenance. The criticism is malicious in both its misdirection and obfuscation.
1. Blaming Judges of Practicing Medicine without a License: http://www.huffingtonpost.com/entry/common-sense-wins-in-ny_560ae76ce4b0dd8503097d54
2. Blames Law Enforcement for Arresting Addicts for their misdeeds: http://www.nytimes.com/2015/10/31/us/heroin-war-on-drugs-parents.html?_r=0
3. Blaming Governor Baker for asking for involuntary treatment of Addicts: http://nepr.net/news/2015/10/20/white-house-drug-czar-skeptical-about-bakers-proposal/
4. Blamed doctors for not ordering urine tests for addicts and allowed Sober House operators to order the tests: https://botticellitopreventivemedicine.wordpress.com/2013/12/02/michael-botticelli-letter-to-preventive-medicine-associates/
5. Botticelli blames Drug Courts for not supporting his “Medication-Assisted-Therapy” euphemism for Methadone and Suboxone: http://www.huffingtonpost.com/2015/02/05/drug-courts-suboxone_n_6625864.html
6. Botticelli blames doctors for not prescribing ENOUGH Suboxone: http://www.huffingtonpost.com/entry/obama-administration-heroin_55fa058ee4b0fde8b0ccf192
7. Botticelli blames doctors for starting the Opioid Epidemic: http://www.huffingtonpost.com/entry/doctors-opioid-addiction_55e8e486e4b093be51bb10f2
8. Botticelli Blames Doctors for the Pain Pill Epidemic: http://onpoint.wbur.org/2015/10/06/fda-oxycontin-heroin-opioid-addiction-crisis
9. Botticelli blames lack of money as the reason for the opioid epidemic and believes money is the answer: http://pjmedia.com/blog/white-house-misses-mark-on-opioid-addiction-epidemic-says-phoenix-house-cmo/
10. Botticelli and team blame prescribed opioids for the Heroin Epidemic: http://www.etcada.com/events/heroin-abuse-increases-and-prescription-opioids-are-largely-to-blame-cdc
11. Botticelli Blames lack of Physician Education for Opioid Epidemic: http://judiciary.house.gov/_cache/files/80980670-6080-4230-968f-3d84c99cf258/boticelli-statement.pdf
12. Botticelli Blames Faith Community’s ineffective effort for the Opioid Epidemic: http://www.pbs.org/wnet/religionandethics/2014/09/05/september-5-2014-heroin-faith-community/24028/
13. Botticelli Blames Stigma Attached to Addiction: http://mic.com/articles/128201/the-depressing-reason-presidential-candidates-are-finally-talking-about-drug-addiction
Unfortunately, Massachusetts governor Baker seems to be taking Botticelli’s thirteenth point seriously, rather than taking Dr. Kishore’s Massachusetts Model seriously. See http://commonhealth.wbur.org/2015/11/drug-misuse-stigma-campaign
Especially if you’re being called on the carpet for making racist statements. See http://www.theroot.com/articles/culture/2015/11/_gentler_war_on_drugs_for_whites_is_a_smack_in_black_america_s_face.2.html. Also troubling are Botticelli’s admissions of using marijuana and cocaine, which may have triggered further misdirection. See fifth from last paragraph here:http://www.vice.com/read/why-is-it-still-illegal-to-enter-the-united-states-if-you-admit-to-using-drugs-1102
The full quote by the governor was “I don’t want to be the governor who ends up presiding over 2,500 opioid deaths, or 3,000 in one year … or 3,500.” This was shortened by a Boston Herald editor into the form used in the main text of this article. See http://www.bostonherald.com/news/local_coverage/2015/11/baker_i_don_t_want_to_preside_over_3500_opioid_deaths_a_year
See Appendix A: Autopsy of a Medical Board Reprimand at end of this article: http://chalcedon.edu/research/articles/massachusetts-derails-revolution-in-addiction-medicine-while-drug-abuse-soars/
Dr. Kishore notes others working to integrate substance abuse into primary care medical practice, such as Jeffrey A. Buck: http://content.healthaffairs.org/content/30/8/1402.full.html
Journal of Substance Abuse Treatment 37:1 (2009), p. 1-7. See also http://www.sciencedirect.com/science/article/pii/S0740547209000373