Treatment instead of imprisonment to curb illegal drug use is widely praised. Accordingly, new rehabilitation centers with handsome buildings and credentialed staff are popping up everywhere. These facilities are expensive – parents have lost homes paying for a kid’s treatment in them. Is the expense worth it? Naloxone is hailed as "the life savior" for opioid users. Is it?

As with prisons, the readmission rate to treatment facilities is high. In 2016, 2 million (~1% of US adults) were incarcerated. Of the released, 68% were rearrested within 3 years, and 83% within 9 years. As inmates often share better criminal techniques and most crimes do not result in an arrest, it is unlikely that the remaining 17% were "cured" of criminality.

Well-researched follow-ups on addiction treatments and readmissions are absent. The Addiction Group estimated that in 2022, 55 million (19%) of the 283 million Americans over the age of 11 had a substance abuse disorder [SUD] in the past 12 months. A fourth of those with SUDs (~5% of the US population over age 11) got "treatment;" half of whom entered a "specialty facility" (as for alcohol or opioids). Alas, only 42% (e.g., ~2% of Americans over age 11) completed the specialty program (it is voluntary, so you can leave). Of those completing the program, about 60% (or ~1% of the population over age 11) were "cured" of their SUD.

Comparing recidivism and readmission rates is not apples-to-apples. But multiple substances (e.g., alcohol, marijuana, cocaine) are usually found in those who die with a SUD, so what constitutes a "cure" and how long cures "last" is hard to estimate (e.g., how many with a cocaine SUD get "cured" and acquire a marijuana SUD?). Alcohol is the biggest SUD killer (accounting for 5% of the world’s burden of disease and 5% of deaths according to the WHO [doi:10.1001/jamanetworkopen.2024.24495]. The newest CDC-sponsored study, costing $344 million and lasting 4 years, focused on the death rate of those with opioid SUDs – a decision assuring we wouldn’t be misled by self-reports by those with a SUD.

This new study was a larger test of naloxone [approved as an opioid antagonist in 1971] which had been “shown to reduce rates of deaths due to overdose” in smaller studies. Naloxone is recommended if someone is on an opioid, opioids accompanied by benzodiazepines, or uses opioids illegally. As "the solution," most first responders are mandated to carry it, and many opioid users carry it in case they "get in trouble."

Large-scale studies of the efficacy of opioid treatments in the US are unusual and are especially informative because of their rarity. Being published in the prestigious New England Journal of Medicine [DOI: 10.1056/NEJMoa2401177] assured that failing to "cure" opioid SUDs would be widely known. The treated in this study averaged 47.2 deaths/100,000 v 51.7/100,000 for the untreated. SUD treatments consume so many mental health therapy hours the "no statistical difference" sent a shudder through the industry. Not to worry, summaries of the results in professional or semi-professional journals often included near-by ads for mental health customers. Thus, Psychology Today’s “Find an Addiction Therapist Get the help you need from a therapist near you….” ignored "the science" it had just reported on in favor of getting clients.

We live in an expert-driven society. Experts in the physical sciences have proven their worth by making our lives materially better. Those with similar education in the human sciences (e.g., public health, psychology, medicine) often claim similar powers. The experts in the human sciences head bureaucracies that purport to deal with preventing and curing our mental and physical ills. The head of the National Institute of Drug Abuse [NIDA] bragged “This study [biggest of its kind, evaluated] evidence-based strategies that we know are effective, including medications for opioid use disorder and naloxone.” As the death rates of the treated and untreated were essentially "the same," this study puts in question all kinds of "proven" kinds of opioid treatments as well as treatments for alcohol, psychedelics, etc. At the least, this study should mute the many claiming that if "X" were done, opioid abuse could be eliminated. But notice the quote from the head of the NIDA – bragging that this big new study failed to support what he said were “evidence-based strategies,” he still knew were “effective.”

It should be noted that some SUD sufferers quit or sharply reduce use – on their own. At the same time, some report AA "cured" them, others that Dr. Y helped them quit with naloxone, some other medicament, or a particular counseling technique. Every one of these reports is "true" in a sense as every theory of how to cure seems to work for some people some of the time. Alas, none has worked enough to prove itself a general cure (as naloxone failed in the new opioid study).

The excess deaths and illnesses caused by following the experts on Covid19 should have already made us "expert leery." This new opioid study should deepen our skepticism of "expert opinion" in the human behavior realm still further.

Do we know how to cure addictions, reduce food allergies, or stop suicide?

Chemical or physical processes seem to work the same across the globe. Human activities not so much. We are influenced by where we grew up, where we live, what we know, our willingness to answer questions, share our feelings, etc. Even these vary by country, social class, sex – and who knows what else? So even though the latest study was the best study, humans are so complex and different, that counting the deaths of similarly treated opioid users in another time or place might result in a different outcome.

Today we know more about atoms, chemistry, animal husbandry, etc. And since surveys on reported actions, opinions, or beliefs abound, we also know more about humanity. Our psychiatrists and public health professionals have degrees just like chemists or biologists. But do these degrees include knowledge of how to reduce or cure SUDs? Might their degrees, income, and status incline them toward hubris?

The opioid treatment study is no outlier. As we are supposed to be an empirically driven society, two reports reinforce the possibility that hubris is influencing us more than it should:

In the 1990s, pediatricians became aware of kids dying of peanut allergy (which then meant about 1 of every 147 kids having the allergy). American Academy of Pediatrics [AAP] is full of the socially accredited. Since the media had shown its light on dying kids, the AAP decided it needed to tell parents how to protect them. They, after all, were the experts (look at their name, pediatrics). Why say nothing when their guess was certainly better than nothing? Although empirical studies of the issue didn’t exist, the AAP decided to advise that children should avoid all peanuts before age 3, culminating in the slogan:

“Age 1: start milk. Age 2: start eggs. Age 3: start peanut products.”

Result? “By 2004 …the rate of peanut allergies was soaring. Emergency department visits for peanut anaphylaxis… skyrocketed. The rate had increased 50% from just six years prior, and more than 1,000% from a previous generation. …many schools enacted peanut bans [and], many public health leaders [decreed that] if every parent would comply with the pediatrics association guideline… we … could finally win the war against peanut allergies.” [M Markary 9/19/24 Wall Street J]

The "consensus science" resulted in this Wall Street Journal headline on September 19:

“Pediatricians Created the Peanut Allergy Epidemic.”

Basking in our admiration and full of hubris, pediatricians ended up killing kids by substituting expert opinion for ignorance (instead of just doing nothing)!

The same "consensus science" is showing up in suicide prevention.

Wouldn’t it be nice if we could "do something" about preventing suicides? Our highly paid and powerful experts at the Centers for Disease Control and Prevention have been spending millions on what they claim are “proven methods” to stop suicide. Why else would they put “prevention” in their title?

Yet, as C Weinstock lays out in KFF Health News (9/17/24):

“Decades of national suicide prevention policies haven’t slowed the deaths!”

A suicide label is tricky: lots would rather be told their child had an accident than committed suicide (and if only one vehicle was involved, without a note, how do you know?). But, putting the issue of diagnosis aside, the statistics we currently have suggest the suicide rate is increasing. That should be a red flag. Weinstock reports that “over the past two decades federal officials have started three national suicide prevention strategies.” This April, the new strategy “includes a federal action plan calling for the implementation of 200 measures over the next 3 years.”

200 measures, wow!

Think of the conventions, think of the pamphlets, think of the podcasts!

Who wouldn’t support slowing or stopping suicide – if you could? Yet where is the evidence that the professionals at the CDC know how to slow or stop suicide? We must resist the temptation to “do something” instead of asking for empirical evidence that what we are doing makes sense. In this case, after decades of failure, where is the empirical evidence the CDC can do what it claims and will not, by advertising suicide (via all those pamphlets, ads, podcasts, etc.), inadvertently increase it?

While Prohibition in the 1920s did not outlaw alcohol (you could make your own), its sale was forbidden. Alcohol consumption was reduced markedly. Morbidity and mortality from alcohol-related illnesses, as well as accidents, domestic violence, and criminality went down significantly. But many voters wanted their booze, the camaraderie associated with drinking, and those supporting the public health improvements were not forceful enough to combat the pro-booze voters’ influence on the political process. Those were different times and the laws dealt with a different population. Marijuana wasn’t enjoying widespread distribution and supportive media (not to mention President Biden’s desire to make it legal).

Currently, our legal drugs are seldom more than 25% efficacious (rather good given how well our medications worked in the past). Posing further challenges to attempts at treatment, our illegal drugs – particularly opioids and marijuana – are steadily getting more potent (and growers have found ways to dramatically increase the psychotropic power of hemp).

Almost every theory of how to cure X, or how to reduce Y, will work some of the time. But human beings are so complex in what they fancy, the risks they are willing to take, and how well they self-discipline that no theory or technique works most of the time. When it comes to social policy you want things that work most of the time and hopefully almost all the time. This incredibly well-done survey of trying out methods that were supposedly surefire – bombed.

Having had SUD clients, it is not unusual to have them challenge YOU to cure THEM. If you are only talking to each other, a pretty tall order. If you also give them drugs – and naloxone is the current "savior of choice" – you are betting that it, along with whatever else is floating around in the client’s body, is beneficial. In either case, when they ‘stay hooked to their drug,’ if they come to you for therapy, they often use you so that they can say to their hoarse-from-pleading family members "I tried."

Bottom line? People are so complex that something that doesn’t work in one situation or for one person might work in or for another. University degrees do not equal "useful knowledge" that goes beyond common sense. Spending money often means wasting money (and depriving those who need it) unless there is empirically buttressed reason to spend it that way. Expert opinion is often worthless or close thereto when it comes to changing human behavior.

Pregnant mothers and their young should revert to eating peanut products as happens all over the world – and was once common in the US. Some will develop peanut allergies, and a few will die of it. But until and unless we empirically test and find how to change it without making things worse, "that’s the way it is." Every human psyche and body is a little different, and some of those differences result in allergies, cleft palate (1 of every ~2,000 babies), etc. Even if we run empirical tests, we are often wrong (see the opioid study above), but because we know far less than we think, experts’ educated guesses aren’t only often wrong, they can be dangerous. If we have gone along with a certain rate of some malady (in this case peanut allergies) we should not change how we treat that substance because of experts’ guesses. At the very least, we should first demand some empiricism before funding government or private agencies: 1) to "keep on doing more of what didn’t work the first time (as suicide prevention)," 2) to keep their employees working, or 3) possibly, screw things up (as the pediatricians did), by acting not on empirical findings, but on professional opinion.