tolerance

The March Toward a Pre-Modern Approach to the Treatment of Pain Continues, Undeterred by Science

It seems that no amount of data-driven information can get policymakers to reconsider the hysteria-driven pain prescription policies they continue to put in place.

I can understand lay politicians and members of the press misconstruing addiction and dependency, but there is no excuse when doctors make that error. Yet National Public Radio reports that surgeons in 18 Upstate New York hospitals have agreed on an initiative to limit the amount of pain medicine they will prescribe to postoperative patients discharged from the hospital. The reporter says that researchers “now know” that patients prescribed opioids for postoperative pain “can become addicted” and that “the new prescription guidelines can prevent this particular gateway to abuse.” 

But what does the research show? One recent study published in the BMJ of more than 568,000 “opioid naïve” postsurgical patients followed for 8 years found a total “misuse” rate of 0.6 percent. (“Misuse” includes a range of non-prescribed drug use, from self-medicating with leftover pills to treat an ankle sprain on one extreme to addiction on the other.) Broken down further, the researchers found the misuse rate was 0.15 percent in patients given just one prescription postoperatively and was 0.29 percent in patients who got a second prescription as a refill. 

Multiple highly-respected Cochrane systematic analyses, the most rigorous reviews in the medical science literature, found the addiction rate in chronic noncancer pain patients on long-term opioid therapy to be around 1 percent.

Addiction and dependency/tolerance are two separate entities, but policymakers and many in the media equate the two. But the doctors in Upstate New York should know better. Physical dependence refers to the physiological adaptation to the drug such that abrupt cessation or tapering off too rapidly can precipitate a withdrawal syndrome, which in some cases can be life-threatening. Tolerance is an aspect of physiological adaptation, in which increasing dose of a medication become necessary to achieve the desired effect. Once a patient is properly tapered off of the drug on which they have become physically dependent, they do not feel a craving or compulsion to return to the drug. Dependence and tolerance are seen with numerous types of drugs, from anti-depressants and anti-epileptics to beta-blockers (used to treat hypertension and other cardiovascular conditions).

Addiction, on the other hand, is defined by the American Society of Addiction Medicine as a “chronic disease of brain reward, motivation, memory and related circuitry…characterized by the inability to consistently abstain, impairment in behavioral control, craving” that continues despite resulting destruction of relationships, economic conditions, and health. Addiction has a biopsychosocial basis with a genetic predisposition and involves neurotransmitters and interactions within reward centers of the brain. Some experts believe addiction is a learning disorder in which behavioral patterns are automatized as mechanisms for coping with stress or trauma. A major feature of addiction is compulsiveness. This compulsiveness is why alcoholics or other drug addicts will return to their substance of abuse even after they have been “detoxed” and despite the fact that they know it will further damage their lives. 

Writing in the New England Journal of Medicine in 2016, Drs. Nora Volkow and Thomas McLellan of the National Institute on Drug Abuse explained, “Unlike tolerance and physical dependence, addiction is not a predictable result of opioid prescribing. Addiction occurs in only a small percentage of persons who are exposed to opioids — even among those with preexisting vulnerabilities.”

20% of College Students Say College Faculty Has Balanced Mix of Political Views

The Cato 2017 Free Speech and Tolerance Survey finds only 20% of current college and graduate students believe their college or university faculty has a balanced mix of political views. A plurality (39%) say most college and university professors are liberal, 27% believe most are politically moderate, and 12% believe most are conservative.

College Democrats Less Likely Than Republicans to Think Faculty Is Liberal

Democratic and Republican students see their college campuses very differently. A majority (59%) of Republican college students believe that most faculty members are liberal. In contrast, only 35% of Democratic college students agree most professors are liberal. Democratic students are also about twice as likely as Republican students to think their professors are moderate (32% vs. 16%) or conservative (14% vs. 9%).

Full survey results and report found here.

College Students Agree Student Body is Liberal

Current students believe that most of their campus’ student body is liberal. Fifty-percent (50%) believe that most students at their college or university are liberal, 21% believe most are moderate, 8% believe most are conservative, and 19% believe there is a balanced mix of political views.

Democratic and Republican students largely agree on the ideological composition of their campus student body.

Consequences of Campus Political Climate

These perceptions of ideological homogeneity on college campuses may explain why 72% of Republican college students say the political climate prevents them from saying things they believe because others might find them offensive. About a quarter (26%) of Republican college students feel they can share their political views.

Is Supporting Racists’ Free Speech Rights the Same as Being a Racist?

Student protesters at the College of William and Mary recently shut down a campus speaker from the ACLU invited (ironically) to speak about “Students and the First Amendment.” Students explained their shut down was in retaliation for the ACLU’s defense of white nationalists’ free speech rights in Charlottesville, Virginia where a white nationalist rally recently took place. What motivated the students?

The Black Lives Matter of William and Mary student group wrote on their Facebook page, where they live-streamed their shut down of the event: “We want to reaffirm our position of zero tolerance for white supremacy no matter what form it decides to masquerade in.” From these students’ perspective, the ACLU supporting someone’s right to say racist things was as bad as being a racist organization.

The Cato 2017 Free Speech and Tolerance Survey helps shed light on these students’ reasoning. First, nearly half (49%) of current college and graduate students believe that “supporting someone’s right to say racist things is as bad as holding racist views yourself.” This share rises to nearly two-thirds among African Americans (65%) and Latinos (61%) who agree. Far fewer white Americans (34%) share this view.

Poll: 71% of Americans Say Political Correctness Has Silenced Discussions Society Needs to Have, 58% Have Political Views They’re Afraid to Share

The Cato 2017 Free Speech and Tolerance Survey, a new national poll of 2,300 U.S. adults, finds that 71% Americans believe that political correctness has silenced important discussions our society needs to have. The consequences are personal—58% of Americans believe the political climate prevents them from sharing their own political beliefs.

Democrats are unique, however, in that a slim majority (53%) do not feel the need to self-censor. Conversely, strong majorities of Republicans (73%) and independents (58%) say they keep some political beliefs to themselves.

Full survey results and report found here.

It follows that a solid majority (59%) of Americans think people should be allowed to express unpopular opinions in public, even those deeply offensive to others. On the other hand, 40% think government should prevent hate speech. Despite this, the survey also found Americans willing to censor, regulate, or punish a wide variety of speech and expression they personally find offensive:

  • 51% of staunch liberals say it’s “morally acceptable” to punch Nazis.
  • 53% of Republicans favor stripping U.S. citizenship from people who burn the American flag.
  • 51% of Democrats support a law that requires Americans use transgender people’s preferred gender pronouns.
  • 65% of Republicans say NFL players should be fired if they refuse to stand for the anthem.
  • 58% of Democrats say employers should punish employees for offensive Facebook posts.
  • 47% of Republicans favor bans on building new mosques.

Americans also can’t agree what speech is hateful, offensive, or simply a political opinion:

  • 59% of liberals say it’s hate speech to say transgender people have a mental disorder; only 17% of conservatives agree.
  • 39% of conservatives believe it’s hate speech to say the police are racist; only 17% of liberals agree.
  • 80% of liberals say it’s hateful or offensive to say illegal immigrants should be deported; only 36% of conservatives agree.
  • 87% of liberals say it’s hateful or offensive to say women shouldn’t fight in military combat roles, while 47% of conservatives agree.
  • 90% of liberals say it’s hateful or offensive to say homosexuality is a sin, while 47% of conservatives agree. 

The Establishment Comes Up Short

Today Politico Arena asks:

How does the Koran burning controversy relate to the Ground Zero mosque controversy?

My response:

As with the controversy over the Ground Zero mosque, Rev. Terry Jones and his tiny band of followers have a perfect right to burn Korans, but it would be well beyond insensitive to do so. Yet where are the establishment voices drawing the parallels? Where is President Obama, leaping to his defense?

Libertarian Politics in the Media

Peter Wallsten of the Wall Street Journal writes, “Libertarianism is enjoying a recent renaissance in the Republican Party.” He cites Ron Paul’s winning the presidential straw poll earlier this year at the Conservative Political Action Conference, Rand Paul’s upset victory in the Kentucky senatorial primary, and former governor Gary Johnson’s evident interest in a libertarian-leaning presidential campaign.

Subscribe to RSS - tolerance