Solving the Opioid Crisis: How do Opioids Work?


The University of Michigan is teaming up with Coursera to create Teach-Outs which are week-long MOOC lecture series which address problems currently faced in society today. The following are notes for lecture set 3 of Solving the Opioid Crisis.

clauw_190This lecture was given by Daniel Clauw, Professor of Anesthesiology, Medicine (Rheumatology) and Psychiatry at the University of Michigan. He serves as Director of the Chronic Pain and Fatigue Research Center. Until January 2009 he also served as the first Associate Dean for Clinical and Translational Research within the University of Michigan Medical School, and PI of the UM Clinical and Translational Sciences Award (CTSA).

People are mainly focused on the deaths by overdose due to opioids, but another aspect of the epidemic is that many people are on opioids long term due to chronic pain. This is not a good use of opioids, since they do not target many forms of chronic pain, so doctors are no longer prescribing them (as often) for this purpose. Chronic pain that is located in a certain body part (such as in osteoarthritis) can be helped by a small dose of opioids, but pain originates in the nervous system (like fibromyalgia) is not helped by opioids. 

Opioids bind the same receptors as endorphins, so when people are given opioids their endorphin systems are being hijacked. When someone has been on opioids for years, it is difficult to take them off because they no longer have a normally functioning endorphin system. There should be two sets of rules for prescribing opioids: those for people who have been on opioids chronically and those who are newly starting with a pain control regimen. 

Until the 1990s, people who died of opioid overdose were heroine addicts that started on heroine. They were lower socioeconomic class, inner city, and black. Therefore, it wasn’t considered a major problem by the privileged classes. However, in the 90’s, doctors started over-prescribing opioids so that now, 60 to 70 percent of people who die of opioid overdose started with a prescription. That’s something the privileged majority is willing to pay attention to.

This lecture came with the following discussion question: Dan Clauw mentions the pharmaceutical industry’s argument that access to opioids are “a human right”. Do you agree with this sentiment? If so, why? If not, why?

I believe that healthcare and access to proper medications is a human right. However, I do not believe that there is a human right to be pain-free. If the risks of giving opioids outweighs the benefits, then opioids should not be prescribed.



Solving the Opioid Crisis: What are Opioids


The University of Michigan is teaming up with Coursera to create Teach-Outs which are week-long MOOC lecture series which address problems currently faced in society today. Following will be notes for The Opioid Crisis.

michael_smith113This post is notes from an interview with Mike Smith, a Clinical Assistant Professor in the Department of Clinical Pharmacy at the University of Michigan College of Pharmacy and Clinical Pharmacist in Pain and Palliative Care at Michigan Medicine.


An opioid is a class of drug that binds an opioid receptor. Unlike pain medications of other classes, opioids can easily lead to euphoria, particularly in higher doses. Years after doctors started prescribing opioids, scientists found that opioids only work on a certain class of pain; therefore, it had been over- and mis-prescribed for years. The abundance of opioids in the community that resulted from this over-prescription led to increased recreational use and addiction. Dr. Smith feels that the best way to bring the opioid crisis to a halt is to minimize the number of pills that are being prescribed. A good second step to halting the crisis would be to identify opioid misuse earlier in patients.

The interview ends with this discussion question: What kinds of innovative steps could be taken to collect surplus opioids in communities like yours?

I admit that I know little about what steps have already been taken to encourage people to properly dispose of opioids; however, I think a government- (or insurance-) funded program where people are partially reimbursed for returning certain prescriptions to their pharmacies when they don’t need the drugs anymore would be beneficial. The problem is that many tax-payers may not approve of such a use of their money and the insurance companies would also object if they were forced by federal regulation to fund such a program.

Democratic to Authoritarian Rule: Lecture Set 2

Big Fist Over People

These are my notes for the second set of lectures about Democratic to Authoritarian Rule by Professor Arun Agrawal at the University of Michigan. The rest of my notes can be found here.

In his second set of lectures, Professor Agrawal talks about Indira Gandhi’s authoritarian rule in India from June 1975 – March 1977. Gandhi was democratically elected as Prime Minister in 1975, but the election was declared void by the Allahabad High Court due to electoral malpractice. Instead of stepping down after her appeals failed, Indira Gandhi had the President of India declare a state of emergency in India – purportedly because the protests were a danger to the country. During the state of emergency, Gandhi broke all five of the key components of democracy as outlined by Professor Agrawal. When she declared a state of emergency, she shut down electricity to media outlets so that the situation could not be fairly reported. She arrested her opposition, and the ones she couldn’t arrest had to go into hiding. Thus, all five of the key components of democracy (as outlined by Professor Agrawal) were broken: rule of law, freedom of expression, presence of a coherent and organized opposition, a free judiciary, and free and fair elections where all citizens have the right to vote.

The scary thing about this situation is how quickly it happened. One night, people went to sleep in a democracy. When they woke up, they were in an authoritarian regime. Just like that.

For discussion, Professor Agrawal asks: What do you see as the two most important institutions of democratic politics whose decline should set alarm bells ringing for citizens and why?

Of the five institutions of democratic politics, I think the most important should be free and fair elections where all citizens have the right to vote and the rule of law. As I see it, these are the most basic ones that define democracy, and are the easiest to break.


Democratic to Authoritarian Rule – A Teach-Out by University of Michigan

Big Fist Over People

The University of Michigan is teaming up with Coursera to create Teach-Outs which (as far as I can determine) are week-long MOOC lecture series which address problems currently faced in society today. I have belatedly signed up for their Teach-Out “Democratic to Authoritarian Rule” which started on 2/12/2018. 

arun_agrawal_0The first lecture was by Professor Arun Agrawal, who explained how modern democracy can become authoritarian. In both older and modern authoritarianism, the leader/regime attempts to disable the basic building blocks of democracy, such as elections, free press, check and balances on their power, and rule of law. They may also unfairly enforce laws against people of certain race, ethnicity, sexual orientation, etc. For instance, the regime might promote what they call a democratic election, but undermine the election by keeping some populations from voting (like the modern ID laws, which make it difficult for very poor and homeless people to vote) and by calling the election fraudulent when they don’t agree with the outcome. They might undermine the rule of law by criticizing the judicial system when it disagrees with the regime’s own point of view. (Or by removing the Judicial Branch from the list of government branches on the White House webpage.) They can undermine free press by calling it “fake news” and handing out awards for the “fakest” news. They might claim that they are above the law (for instance, are unable to be sued). [Specific examples aimed at Donald Trump are my own insertions.]

Professor Agrawal ends his lecture with a prompt to introduce ourselves by noting any experience we have had with authoritarian politics and/or our concerns about democratic vs. authoritarian tendencies in our own countries:

I am a soon-to-be-married white middle-class woman from the USA, who has been privileged enough to not be personally impacted by what I would consider the authoritarian tendencies of Donald Trump. I can vote, and I’m fairly confident that my vote wasn’t unfairly discounted due to claims of fraud or lack of identification. I have not been banned from traveling, though I personally know people who have been stuck on one side of the border or the other by such bans. I have not been immediately affected (though I expect the impact to come eventually) of Trump’s withdrawal from the Paris Climate Accord, and his denial and suppression of climate change data. Despite my relative safety from these issues, I am very frightened of where Donald Trump’s plans (or lack thereof) are leading the US and the world. I know that if he continues as is, many more people will suffer, and I am saddened by where our county is headed.

However, I also realize that many people felt the same way about Obama (though I can’t imagine how they can rationalize that). I also know that we, in the US, have it pretty good compared to millions others in authoritarian countries. For that, I am grateful.