RED ALERT: Stewart Baker writes at the Volokh Conspiracy: “Congress is Preparing to Restore Quotas in College Admissions … and Everywhere Else–as a Very Quiet Part of the Bipartisan ‘Privacy’ Bill.” I haven’t had a chance to review the bill yet. But the conservative civil rights lawyers who have had that opportunity all agree that this “bipartisan” bill will, if passed, be a disaster. I assume the GOP staffers involved simply didn’t understand the ramifications of the “disparate impact” provisions in the bill. But I’ll know more once I’ve read the bill myself. In the meantime: Dear Congress: Please don’t pass this bill.
(Yes, I noticed Glenn posted this last evening, but it’s important enough to post again.)
A group of migrants try to cross a barbed wire fence to reach the U.S., as seen from Ciudad Juarez, Mexico, on March 20, 2024. (Photo by Herika Martinez via AFP)
While the border crisis has become a major liability for President Biden, threatening his reelection chances, it’s become a huge boon to a group of nonprofits getting rich off government contracts.
Although the federally funded Unaccompanied Children Program is responsible for resettling unaccompanied migrant minors who enter the U.S., it delegates much of the task to nongovernmental organizations (NGOs) that run shelters in the border states of Texas, Arizona, and California.
And with the recent massive influx of unaccompanied children—a record 130,000 in 2022, the last year for which there are official stats—the coffers of these NGOs are swelling, along with the salaries of their CEOs.
“The amount of taxpayer money they are getting is obscene,” Charles Marino, former adviser to Janet Napolitano, the secretary of the Department of Homeland Security under Obama, said of the NGOs. “We’re going to find that the waste, fraud, and abuse of taxpayer money will rival what we saw with the Covid federal money.”
The Free Press examined three of the most prominent NGOs that have benefited: Global Refuge, Southwest Key Programs, and Endeavors, Inc. These organizations have seen their combined revenue grow from $597 million in 2019 to an astonishing $2 billion by 2022, the last year for which federal disclosure documents are available. And the CEOs of all three nonprofits reap more than $500,000 each in annual compensation, with one of them—the chief executive of Southwest Key—making more than $1 million.
Some of the services NGOs provide are eyebrow-raising. For example, Endeavors uses taxpayer funds to offer migrant children “pet therapy,” “horticulture therapy,” and music therapy. In 2021 alone, Endeavors paid Christy Merrell, a music therapist, $533,000. An internal Endeavors PowerPoint obtained by America First Legal, an outfit founded by former Trump aide Stephen Miller, showed that the nonprofit conducted 1,656 “people-plant interactions” and 287 pet therapy sessions between April 2021 and March 2023.
Endeavors’ 2022 federal disclosure form also shows that it paid $5 million to a company to provide fill-in doctors and nurses, $4.6 million for “consulting services,” $1.4 million to attend conferences, and $700,000 on lobbyists. In 2021, the NGO shelled out $8 million to hotel management company Esperanto Developments to house migrants in their hotels. Endeavors, which gets 99.6 percent of its revenue from the government according to federal disclosure forms, declined to comment to The Free Press.
The Administration for Children and Families, a division of the U.S. Department of Health & Human Services, funds the nonprofits through its Office of Refugee Resettlement, and its budget has swelled over the years—from $1.8 billion in 2018 to $6.3 billion in 2023. The ORR is expected to spend at least $7.3 billion this year—almost all of which will be funneled to NGOs and other contractors.
When asked about the funding increase during a January media event, Krish O’Mara Vignarajah, the chief executive of Global Refuge said, “We’ve grown because the need has grown.” The nonprofit did not make Vignarajah available for an interview.
But while it’s true the number of migrants has exploded in recent years, critics say these enormous federal grants far exceed the current need. The facilities themselves are generally owned by private companies and are leased to the NGOs, which house the unaccompanied minors and attempt to unite them with family members or, if that’s not possible, people who will take care of them—their so-called sponsors. The ORR does not publicly list the specific number of shelters it funds in its efforts to house migrants, a business The New York Timesonce described as “lucrative” and “secretive.”
While some NGOs have long had operations at the border, “what is new under Biden is the amount of taxpayer money being awarded, the lack of accountability for performance, and the lack of interest in solving the problem,” said Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a think tank that researches the effect of government immigration policies and describes its bias as “low-immigration, pro-immigrant.”
Consider Global Refuge, based in Baltimore, Maryland. In 2018, according to its federal disclosure form, the Baltimore-based nonprofit had $50 million in revenue. By 2022, its revenue totaled $207 million—$180 million of which came from the government. That year, $82 million was spent on housing unaccompanied children. Global Refuge also granted $45 million to an organization that facilitates adoptions as well as resettling migrant children.
Now Global Refuge employs over 550 people nationwide, and CEO Vignarajah said in January that the nonprofit plans to expand to at least 700 staffers by the end of 2024.
Vignarajah, a former policy director for Michelle Obama when she was first lady, took the top job at Global Refuge in February 2019 after she lost her bid to be elected governor of Maryland. She has since become one of the most prominent advocates for migrants crossing the southern border, appearing frequently on MSNBC and other media as an immigration advocate. Her incoming salary was $244,000, but just three years later, her compensation more than doubled to $520,000.
In 2019, Global Refuge housed 2,591 unaccompanied children while spending $30 million. Three years later, the NGO reported that it housed 1,443 unaccompanied children at a cost of $82.5 million—almost half the number of migrants for more than double the money.
In a statement to The Free Press, Global Refuge spokesperson Timothy Young said that while in care, “Unaccompanied children attend six hours of daily education and participate in recreational activities, both at the education site and within the community.”
The man with the $1 million salary is Dr. Anselmo Villarreal, who became CEO of Southwest Key Programs, headquartered in Austin, Texas, in 2021. (Villarreal took a drop in pay compared to his predecessor, Southwest Key founder Juan Sanchez, who paid himself an eye-popping $3.5 million in 2018.)
Despite a number of scandals in the recent past, including misuse of federal funds and several instances of employees sexually abusing some of the children in its care, Southwest Key continues to operate—and rake in big government checks. In 2020, the year of Covid-19, its government grant was $391 million; by 2022, its contract was nearly $790 million.
Southwest Key’s federal disclosure forms show that in 2022, six executives in addition to Villarreal made more than $400,000, including its chief strategist ($800,000), its head of operations ($700,000) and its top HR executive ($535,000). Its total payroll in 2022 was $465 million.
Endeavors, Inc., based in San Antonio, Texas, is run by Chip Fulghum. Formerly the chief financial officer of the Department of Homeland Security, he signed on as Endeavors’ chief operating officer in 2019 and was promoted to CEO this year.
In 2022, Fulghum was paid almost $600,000, while the compensation for Endeavors’ then-CEO, Jon Allman, was $700,000. Endeavors’ payroll went from $20 million in 2018 to a whopping $150 million in 2022, with seven other executives earning more than $300,000.
Perhaps the most shocking figure was the size of Endeavors’s 2022 contract with the government: a staggering $1.3 billion, by far the largest sum ever granted to an NGO working at the border. (In 2023, Endeavors’ government funds shrank to $324 million because the shelter was closed for six months. Endeavors says this was because the beds were not needed, the border crisis notwithstanding.)
Despite these astronomical sums, the Unaccompanied Children Program is fraught with problems and suffers from a general lack of oversight. Because so many unaccompanied youths are crossing the border, sources who worked at a temporary Emergency Intake Site in 2021 said the ORR pressured case managers to move children out within two weeks in order to prepare for the next wave of unaccompanied children.
In 2022, Florida governor Ron DeSantis empaneled a grand jury to conduct an investigation, which showed how the ORR continually loosened its safety protocols so children could be connected to sponsors more quickly—and with less due diligence. The same report revealed that because there’s often no documentation to prove a migrant’s age at the time Border Patrol processes them, 105 adults were discovered posing as unaccompanied children in 2021. One of them, a 24-year-old Honduran male who said he was 17, was charged with murdering his sponsor in Jacksonville, Florida.
“We used to have DNA testing to make sure we had these family units,” Chris Clem, a recently retired Border Patrol officer, told The Free Press. But since the border crisis, the ORR has abandoned DNA testing, according to congressional testimony by the General Accountability Office. In 2021, ORR revised its rules so that public records checks for other adults living in a prospective sponsor’s home were no longer mandatory.
Tara Rodas, a government employee who was temporarily detailed to work at the California Pomona Fairplex Emergency Intake shelter in 2021, told The Free Press she also uncovered evidence of fraud within the sponsorship system. “Most of the sponsors have no legal presence in the U.S. I don’t know if I saw one U.S. ID,” said Rodas. “There were no criminal investigators at the site, and there was no access to see if sponsors had committed crimes in Guatemala, El Salvador, and Mexico.”
Last October, the ORR published a series of proposed changes to its regulations in the Federal Register that will effectively codify the more relaxed standards. The new regulations, which will go into effect in July, will allow background checks and verifying the validity of a sponsor’s identity—but wouldn’t require them.
“It is mind-boggling that ORR has not seen fit to adjust the policies for (unaccompanied children) placements, except to make them more lenient,” Jessica Vaughan at the Center for Immigration Studies told The Free Press. “They could do a much better job, but they only want to streamline the process and make the releases even easier.” The Administration for Children and Families did not respond to emailed questions from The Free Press.
Deborah White, another federal employee temporarily detailed to the Pomona Fairplex facility in 2021, told The Free Press: “Ultimately, the responsibility is on the government. But the oversight is obviously not adequate—from the contracting to the care of the children to the vetting of the sponsors. All of it is inadequate. The government blames the contractor and the contractor blames the government, and no one is held accountable.”
If you weren't thinking about these things already, if you are Israel or India or Saudi Arabia, you will certainly be asking yourself: How can I safeguard myself, as much as possible when it comes to my wealth or defense, from American fecklessness?
— Alberto Miguel Fernandez (@AlbertoMiguelF5) May 9, 2024
If you’re from a country that doesn’t have emotional support animals, here’s how it works.
Sometimes places ban or restrict animals. For example, an apartment building might not allow dogs. Or an airline might charge you money to transport your cat. But the law requires them to allow service animals, for example guide dogs for the blind. A newer law also requires some of these places to allow emotional support animals, ie animals that help people with mental health problems like depression or anxiety. So for example, if you’re depressed, but having your dog nearby makes you feel better, then a landlord has to let you keep your dog in the apartment. Or if you’re anxious, but petting your cat calms you down, then an airline has to take your cat free of charge.
Clinically and scientifically, this is great. Many studies show that pets help people with mental health problems. Depressed people really do benefit from a dog who loves them. Anxious people really do feel calmer when they hold a cute kitten.
Legally, it’s a racket. In order to benefit from these rules, you need for a psychiatrist to write you an “emotional support animal letter”, saying that your pet is actually an emotional support animal. In theory, the psychiatrist should evaluate you carefully, using their vast expertise to distinguish between an emotional support animal and a normal pet. In practice, nobody has a rubric for this evaluation that makes sense. I’m not saying there aren’t long, scholarly-sounding papers with twenty-seven authors from the psychiatry departments of top medical schools called things like A Rubric For The Emotional Support Animal Evaluation That Makes Sense. I’m saying that when you take out all the legalese, the executive summary is “think really hard about whether this animal really helps this person, then think really hard about whether it will cause trouble, and if it helps the person and won’t cause trouble, sign the letter”.
Here’s a typical case: you’ve been seeing a patient with depression for three years. You prescribe them medication, maybe they get a little better, maybe they go up and down randomly in the way of all depression patients. Then they say “My roommate is leaving, so I need to move to a new apartment. But almost nowhere allows dogs, and the only place that does allow them charges more than I can afford. Please write me an emotional support animal letter or else I’ll lose my beloved Fido, the light of my life.”
So you say, okay, I’ve got to do an evaluation to see if you’re really depressed. They say “You’ve been treating me for depression for three years, you’ve prescribed me six different antidepressants, come on.” You say okay, fine, I’ll skip that part, but I’ve got to do an evaluation to see if your animal really helps you. They say “I feel so much better whenever I’m with Fido, he really brightens up my day.” You ask the same question several times, in the manner of all psychiatrists, and your patient always gives the same answer. Then you say “I’ve got to evaluate whether your animal is safe,” and he says “Oh yeah, Fido is such a good boy, he would never hurt a fly.” Now what?
You could keep evaluating harder. You could make them bring Fido into your office (good luck!) and observe him. The observation would look like your patient petting a dog for a half-hour appointment, for which you charge them $200. You could get “collateral history” from friends and family: “Is Fido really a good boy? Does your cousin seem happier when Fido is around?” At some point this becomes insane and humiliating. Good luck figuring out which point that is.
Or you could do the ultra-responsible thing and deny the letter. You could say “As your psychiatrist, I inherently have a conflict of interest; I know you, I like you, I can’t be objective in this determination.” Now your patient will hate you forever. Every other doctor gives their patients emotional support animal letters. The only other psychiatrist in town charges $500 per appointment and demands at least ten appointments before they will write an ESA letter, they’ll never be able to make it work, they’ll lose Fido. They’ll lose Fido and it will be your fault and they’ll hate you forever and they will never take any of the medication you recommend ever again even if they’re suicidally depressed and you’re the last psychiatrist in the world.
Or you could stop dithering and just write the damn emotional support animal letter. It doesn’t have to be more than a few sentences. If you Google “emotional support animal letter”, it autocompletes to “…template”. There are hundreds of them!
This option has basically no downsides and is the one that most psychiatrists end up taking.
And it’s harmless enough with Fido - he really is a good boy. But I’ve had patients with ADHD ask me to certify their snake. Sorry, I refuse to believe a snake can help you with ADHD, unless it’s one of those talking snakes from Harry Potter and it whispers “Concccccentrate . . . conccccccentrate” in your ears every time you start slacking off. Still, some patients argue very eloquently: “Taking care of the snake helps me keep to a routine, and makes me feel more confident, and she’s my only friend in the world, and I feel like I’d be stressed and lost without her.” It’s a little weird. But do you really want your patient to lose their beloved Nagini just because you refused to write a letter that has no legal requirements and no downsides?
Probably it’s bad that society is so hostile to pets. Probably it’s bad that we’ve reached the level of housing shortage where landlords don’t need to compete for tenants, and they might as well ban all pets if it makes their lives even slightly easier. Probably the emotional support animal loophole makes things better rather than worse.
But the process runs into the same failure mode as Adderall prescriptions: it combines an insistence on gatekeepers with a total lack of interest over whether they actually gatekeep. The end result is a gatekeeping cargo cult, where you have to go through the (expensive, exhausting) motions of asking someone’s permission, without the process really filtering out good from bad applicants. And the end result of that is a disguised class system, where anyone rich and savvy enough to engage with the gatekeeping process gets extra rights, but anyone too poor or naive to access it has to play by the normal, punishingly-restrictive rules.
I have no solution to this, I just feel like I incur a little spiritual damage every time I approve somebody’s ADHD snake or autism iguana or anorexia pangolin or whatever.
Less than a day before the Biden administration announced its intent to cut off U.S. arms sales to Israel, it issued a sanctions waiver to bypass congressional prohibitions on arms sales to a host of Arab nations that boycott the Jewish state, including Hamas ally Qatar and Iran-controlled Lebanon, the Washington Free Beacon has learned.
On Tuesday—just a day before President Joe Biden threatened to withhold key weapons deliveries from Israel if the country moves forward with an incursion in the Gaza Strip’s Rafah neighborhood—the State Department informed Congress that it intends to bypass laws that bar the United States from selling weapons to nations that boycott Israel, according to a copy of the notification obtained by the Free Beacon.
The Biden administration, which has waived these sanctions in the past, said in the notification that it intends to extend the waiver through April 30, 2025, allowing weapons to be sent to a host of nations that work closely with the Hamas terror group and other Iran-backed terror proxies.
Bailey will unveil the “Farming for Nature” scheme at Leckford, the Waitrose farm in Hampshire where they have been farming regeneratively since 2020. The supermarket wants to source “as much as possible” of its UK meat, milk, eggs, fruit and vegetables from farms that use regenerative practices, such as reducing pesticide use and ploughing and turning over field margins to pollinators. The aim is that by 2035, all of its UK supply chain for these items will be from regenerative farms. It is aware it will be a huge learning curve for Waitrose farmers and can’t predict how many will sign up, but Bailey is determined that the supermarket should lead the way.
“I think there was a point at which we realised we had to do something,” he says. It sounds very noble, but some would say supermarkets have a major part to play in getting where we are now, having engaged in a systematic price war that has pushed farmers into intensification. Does Bailey, who worked for Sainsbury’s for 18 years – starting in the fresh food department and working his way to become its grocery buying director, before he joined Waitrose in 2020 – feel guilty?
He laughs awkwardly. “I feel responsible,” he says. “I’m part of a generation of people who are in the right place at the right time to make a change. And I feel that burden.”
“I think we’re seeing the end of the era of cheap food, because of the impact of that cheap food – not just on people’s health but the external impact, the environmental impact, the societal impact of that cheap food. We need to witness the end of cheap food and a reversal of the value of the food people are eating.”
The ghost of FDR smiles; as Amity Shlaes wrote, in the 1930s, “Roosevelt led the country in passing the Agricultural Administration Act, which taxed middlemen in order to give a greater share of revenue to farmers. The Act also restricted production and sent subsidies to those on the farm. Six million young pigs were killed early to drive up pork prices; farmers were instructed to plow crops under.”
The backlash over the settlement of Northwestern University with pro-Palestinian protesters continues to mount. In a letter acquired by The Daily Northwestern, seven out of 11 members of the “President’s Advisory Committee on Preventing Antisemitism and Hate” resigned this week in protest.
Under the controversial agreement, the school will admit five Palestinian students each year, support two Palestinian faculty members annually, create special housing for Muslim students, and add students to Committees to review purchases from Israeli businesses.
The resigning committee members criticized NU President Michael Schill’s failure to seek advice from the committee regarding the agreement.
The Anti-Defamation League criticized the deal, writing: “Instead of holding the perpetrators accountable, the university rewarded them. It would be unbelievable if it wasn’t true.”
Brown University has also been the target of criticism over its settlement with protesters, including a pledge by Brown President Christina Paxson to consider the divestment from all Israeli businesses.
Rutgers may be the next flashpoint for such criticism after agreeing this week to all but two demands by protesters.
— Rutgers accepting “at least 10 displaced Gazans” to complete their studies at the university.
— Plans to create an “Arab Cultural Center” by the fall semester at every Rutgers campus.
— Creation of a “memorandum of understanding” and “long-term educational partnership” with the West Bank’s Birzeit University.
— Use of “Palestine” and “Palestinians” instead of “Middle East” or “Gaza region” in all official university communications regarding “Israeli aggressions in Palestine.”
— Training for university staff and the hiring of experts in “anti-Palestinian, anti-Arab and anti-Muslim racism.”
— Display of flags on campus of “Palestinian, Kurdish, Kashmiri and other disputed territories.”
— “Full amnesty to all faculty, staff, student organizations and students” who took part in the Rutgers anti-Israel encampment and protests the past week.
The two items not agreed upon — divestment from companies that do business with Israel and ending Rutgers’ partnership with Tel Aviv University and the HELIX Innovation Hub — will be dealt with later by the university.
#RESIST: Prison Guard Resigns After ‘Immoral, Dangerous’ Trans Policies. “At the peak of his career as a correctional lieutenant inside the California Prison system, Hector Bravo Ferrel couldn’t take anymore. Things became dangerous and unethical, he said, after the state passed SB 132, a law that required prison guards to transfer convicts from the men’s prison to the women’s prisons. The law also allowed male inmates who identify as women to demand they be searched—in the nude—by female prison staff. Ferrel walked away from his stable, lucrative career to blow the whistle on “backwards” policies inside the correctional world that he says put female prison staff and inmates at risk.”
Editor’s note: the following is the first essay in a series, written by former Moscow Times co-worker and current E.R. doctor Matt Bivens. The remaining features will be published serially on his Substack site, . None of the articles in the series will be paywalled.In a normal presidential election year, the opiate addiction crisis would be a front-and-center domestic issue, but for a variety of mostly illegitimate reasons, it flies somewhat under the radar. Matt’s series chronicles the surprising and little-understood reasons contributing to this man-made, rapidly worsening disaster.
Yes, we in the medical profession got millions of Americans addicted to heroin and fentanyl. But that was all just a big misunderstanding. Why get into it?
And sure, nearly one in ten adults has had a family member die from a drug overdose. Ordinary people are furious about it, too. Their under-appreciated rage drove skepticism of official COVID-19 narratives, and that same rage might sway the outcome of the Presidential election — heck, might even land us in a war with Mexico! (Wouldn’t that be the ultimate “Wag the Dog”-level distraction from those sociopaths upstairs in our House of Medicine!)
So, yes, agreed. All good points.
We medical people who see the patients and do all of the work — we, the house staff — we’re downstairs people. We can’t do anything about what goes on above. Agreed, it’s shameful how easily the upstairs sociopaths conned us, and it’s annoying to see them now so fabulously rich. But doctors being intentionallymanipulated into destroying the lives of millions — that could have happened to anyone. Why stay angry about it? Ancient history! It’s not like it’s still happening, right? (Right?)
Surely you don’t want to burn down the entire house? We work here. And the pay is not bad. Let’s just focus on the patients before us, and try to stay positive. Right?
Heroin™ — brought to you by Bayer!
As a medical student, I was once told by my attending physician that people treated with morphine for pain don’t get addicted.
Surprised, I asked, “But what about all the Civil War veterans?”
When the U.S. Civil War ended in 1865, both sides demobilized a weary horde of chronically ill and wounded. Some soldiers had contracted tuberculosis, or a lingering pneumonia (in the days before antibiotics). Others had suffered field amputations with handheld saws. But whether the question was chronic coughing or terrible pain, the answer was morphine. The newly invented hypodermic needle allowed for fast-acting injections. Veterans everywhere got hooked, to the point where addiction was called “the Soldier’s Disease.” Soon morphine moved beyond the battlefield and was in use for everything from menstrual cramps to teething.
Vintage ad for a morphine-based child’s medicine. From the DEA’s online museum.
Things got so bad that when heroin (diacetylmorphine) arrived, it was welcomed as an improvement. Chemists had discovered it decades earlier, but in 1898 the pharmaceutical company Bayer started selling it as Heroisch, German for “heroic.”
Heroin was a trade name. It was Heroin™ — brought to you by Bayer!
Doctors desperate for something safer than morphine often convinced themselves this new drug wasn’t addictive.
“Heroin… possesses many advantages over morphine,” wrote a physician in 1900, in the precursor to the New England Journal of Medicine. “It is not a hypnotic… [and there is no] danger of acquiring the habit.” The philanthropic St. James Society even mounted a campaign to mail free heroin samples to morphine addicts (!), to help them break the habit.
From the DEA online museum. Note it says “Trademark.”
Other doctors saw the public swilling down heroin and berated their fellow physicians for not sounding the alarm.
“The patient comes to look on heroin as a harmless sedative for his cough,” wrote one such physician in 1912, in the Journal of the American Medical Association, because too many doctors think it’s safe:
“A patient who came under my observation told a physician, who was called to treat him for an attack of laryngitis, not to give him anything that contained opium, because he had formerly been a slave to this drug. The physician replied: ‘I will give you some heroin; there is no danger of habit from that’.”
Ordinary Americans weren’t buying it, and by 1906 we had established the federal Food & Drug Administration, because moms want to know if it’s got heroin. Cure-alls like the morphine-and-alcohol-based Mrs. Winslow’s Soothing Syrup definitely did quiet fussy babies, but it’s believed thousands never woke up again.
President Teddy Roosevelt appointed an “Opium Commissioner,” who looked around and saw track marks on the arms of everyone from aging Army of the Potomac vets to high society ladies, and declared, “Americans have become the greatest drug fiends in the world.” It was our first Opioid Crisis. It had been driven by genuine ignorance and a lack of good alternatives — but tellingly, also by the inappropriate use of heavily marketed and physician-endorsed treatments. In response, the nation went on a scorched-earth campaign against all addictive substances, starting with new anti-narcotics agencies staffed by G-men in trench coats, and culminating in the U.S. Constitutional amendment to ban alcohol. Again: We rewrote the Constitution to outlaw alcohol. That we once went so far suggests how bad things had gotten.
This all seems like a glaringly obvious cautionary tale for the House of Medicine. Yet somehow, not 70 years after the nation had walked away from the Prohibition experiment, medical schools — medical schools! — were abruptly teaching that opioids weren’t necessarily addictive.
When my attending said a patient wouldn’t get addicted if a doctor gave morphine for pain, he was simply channeling what all the best people were saying. For example, in 2000, the Joint Commission — an independent non-profit that sets accreditation standards for hospitals — published a book for physician education that claimed:
There is no evidence that addiction is a significant issue when persons are given opioids for pain control.
No evidence. And if the medical students ask about morphine-enslaved Civil War veterans? The Joint Commission’s book dismisses such concerns as “inaccurate and exaggerated.”
It was the same over at the Federation of State Medical Boards — a trade organization for the bodies in each state that license, investigate and discipline doctors. A set of FSMB guidelines from this era sternly stated that opioids are “essential” for treating various kinds of pain, and only mentioned addiction to warn that “inadequate understandings” of that could lead to “inadequate pain control.”
I was literally told by my attending — who was just echoing those who accredit the hospitals and license the doctors — to “do more reading.” That’s a common directive to a medical student: Stop with the skeptical questions and go study.
From 20,000 deaths a year, to 50,000, to now 80,000
At the turn of the century, about 20,000 people each year would take an opioid — as a pill, or as a snorted or injected powder — and then stop breathing and die. Those of us working on ambulances or in emergency departments could not save them.
But for every death, there are about 20 non-fatal overdoses. So, with bag mask ventilation and opioid reversal agents, we have dragged millions of people back to life. How many suffered anoxic brain injuries, and today are mentally a half-step slower? Unknown.
Overdoses at this scale were a new development, and they were occurring hand-in-hand with the aggressive new marketing and prescribing of opioids. This is the era chronicled so well by popular miniseries — “Dopesick” on Hulu, “Painkiller” on Netflix. In the midst of it, the Sackler family-owned Purdue Pharma pled guilty to a deception campaign meticulously designed to bring about recklessly liberal opioid prescribing. As punishment, the company had to shell out $600 million, and three top executives got multi-million-dollar fines and 400 hours of community service.
That should have been peak “Opioid Crisis.” But it was only 2007. Heck, George W. Bush was still president. The Sacklers were never contrite. They’d been raking in about $1 billion a year for more than a decade. The $600 million fine sounded impressive — but the Sacklers shrugged, cut the government in to the tune of less than 5% of the cash rolling in, and got right back to slinging opioids. And in the 17 years since, everything has gotten terribly worse.
Did it feel like a catastrophe back in 2007, when 20,000 people a year would die, and people were enraged at Purdue?
Or a decade later, in 2017, when President Donald Trump declared it a national emergency, and 50,000 people a year would die?
That’s nothing. For the past three years, we’ve reliably seen 80,000 people each year take an opioid, stop breathing and die.
From CDC data. Numbers have continued to climb through 2023. Accessed at the National Institute on Drug Abuse.
Opioid overdoses accelerated amidst the despair of COVID-19 lockdowns. These days, it’s completely routine for a private car to brake with screeching tires at our emergency department entrance, with the driver screaming about someone in the back seat who is floppy, gray, not breathing. The overhead announcement of “trigger to triage!” used to get nurses and techs running excitedly to the front door. Now, they respond at a walk — a briskly respectful walk, but it’s clear no one’s particularly excited. The novelty wore off long ago.
The Olympics of Sociopathy
Back when Purdue Pharma had to pay $600 million, that was big news. Today, judgments are handed down left and right for billions, without much comment or public excitement, against everyone involved in making, distributing or selling opioids: $17.3 billion from CVS, Walmart and Walgreens, $5 billion from Johnson & Johnson, $21 billion from opioid distribution companies McKesson, Cardinal Health and AmerisourceBergen, $4.25 billion from Teva Pharmaceuticals, $2 billion from Allergan.
Meanwhile, an agreement to let the Sackler family skate while Purdue surrenders $6 billion and goes bankrupt is before the U.S. Supreme Court. (For context, Purdue has earned far more than $30 billion from opioids by now. Forbes estimates the Sacklers as individuals are worth more than $10 billion; attorneys general argue the family has hidden billions more abroad. The Sacklers have for years sold more opioids via Rhodes Pharmaceuticals, a Rhode Island-based company they quietly control, than via Purdue).
Pondering these massive new settlements, I remember thinking, “Walmart? Johnson & Johnson? Surely some innocents have been caught up in an indiscriminate dragnet?”
Wrong. Don’t look into this if you don’t want to know. Like competitive bicyclists, many had lined up to slipstream behind Purdue Pharma and its deranged, anti-social marketing of OxyContin®. Perhaps none of those other corporations would have dared try to convince physicians and nurse practitioners to hand out opioids like candy. But the Sacklers dared and met with success — instant success, shocking success, in perhaps the most shameful episode in the history of medicine.
The other companies might have been surprised, but they all fell eagerly in line behind. Each of them drafted in the turbulent wake of Purdue opioid marketing — some just coasting and enjoying the free money, others so excited they would at times sprint out ahead to briefly take the lead in this Olympics of Sociopathy.
For example, it may have been the Sacklers who first decided to target returning veterans (who have good health insurance) as an opioid growth market — veterans, by the way, are three times more likely to overdose and die than other Americans.
From page 18, paragraph 56, of the Massachusetts attorney general’s 2019 lawsuit against Purdue & the Sacklers.
But it took a Johnson & Johnson-backed organization, the “Imagine the Possibilities Pain Coalition”, to spitball in 2011 about targeting elementary school students. After all, third graders have pain, too! A PowerPoint presentation from this group noted we could start marketing opioids to kids “via respected channels, e.g., coaches.”
Slide from the group’s 2011 internal presentation. Accessed at the UCSF Opioid Industry Documents Archive.
Johnson & Johnson also quietly funded the 2013 launch of “Growing Pains”, “a new social networking site for young people with pain”. This effort to market opioids to teenagers aged 13 and up was shut down only as of 2021.
From Oxy to Heroin to Fentanyl to … Buprenorphine?
Today nearly every 10th adult has lost a family member to an opioid. All major candidates for president have tapped into the anger — which, however, they have chosen to direct at Chinese and Mexican cartels.
Florida Governor Ron DeSantis vowed if elected president to send U.S. special forces into Mexico (!) to take out fentanyl labs. Trump as president reportedly talked about shooting missiles into Mexico to destroy said labs. President Joe Biden has pledged to “stop [fentanyl] pills and powder at the border.”
So, the newly agreed-upon villains are foreigners.
Did something change?
Yes and no. It turns out the Opioid Crisis — that catchall term for this 25-year-long blizzard of addiction, overdose and death — has gone through different stages, much like how COVID-19 would cycle through variants, from Delta to Omicron. But while COVID quickly mellowed, the Opioid Crisis has just gotten nastier.
The CDC identifies three waves: First came the prescription wave of the late 1990s and early 2000s, which launched the entire enterprise. Next came the heroin wave, which per the CDC roughly started in 2010, when the prescription-addicted turned to the streets. From about 2013 to today, we have been awash in synthetic opioids like fentanyl (heroin requires farming poppies, but fentanyl is cheaply made in labs).
Graphic accessed at the CDC. Look at how steeply the death rate is climbing today!
But wait long enough, and Big Pharma always wins. Amoral, soulless corporations — often the same ones paying out massive settlements — have maneuvered skillfully to reassert control over the addiction market they’ve created. The goal now is to create a fourth and final wave of the Opioid Crisis: the buprenorphine wave. We will start as many people as possible on this ingenious opioid.
Buprenorphine, the main ingredient in brand names such as Suboxone® and Subutex®, is a so-called partial opioid agonist: It latches tightly onto opioid receptors but stimulates them only slightly — just enough for a person with physical addiction to not experience withdrawal. A person on appropriately dosed buprenorphine is not sedated or high, they just “feel normal.” (What’s more, even if they were to inject fentanyl, the opioid receptors are already locked down by the buprenorphine, which blocks other opioids from getting through.)
I can’t argue against expanded use of buprenorphine. The data clearly shows that it prevents death and disability. People really do get control of their lives again. Of course, it is also addictive. So, the plan we confidently propose is to treat opioid addiction with this admittedly ingenious and excellent medication, for a monthly price tag, depending on the formulation, ranging from $196 to $1,136… forever.
What’s not to like?
Big Pharma, Finally Unmasked
Medicine has wrought amazing breakthroughs, and we have professed high moral standards. But some of us aren’t above indulging in the same “Braindead Megaphone”-style pronouncements plaguing the rest of society: sternly shouting down even the meekest questions about pediatric gender reassignment therapies or vaccine mandates, for example. When it comes to the Opioid Crisis — this massive, deadly pandemic of addiction we’ve unleashed — we stroll past whistling and look guiltily away, then whirl back around, whip out the Braindead Megaphone, and loudly announce that we expect to be paid handsomely to provide additional addictive opioids to treat this same pandemic. We declare this with wide-eyed innocence, and get indignant if anyone questions this plan — even as internal corporate communications now available show Big Pharma corporations rubbing their hands gleefully at the thought of all of that buprenorphine cash.
That’s right: internal corporate communications — millions of pages — are now available. They can be searched online at the Opioid Industry Documents Archive, hosted by University of California San Francisco (UCSF).
I thought I knew a lot about the Opioid Crisis. After all, I’d been a reluctant front-line participant in it for 20 years, as a paramedic, a medical student and a physician.
Then the lawsuits arrived, and the Archive opened.
Next: A conspiracy to taint the medical literature
Trumps participation in the totalitarian despotism of the covid response gives me great pause in voting for him. Though, at least he didn't mandate the vaccine.
Note to Substack readers: this is an updated version of an article first published on brownstone.org.
Donald Trump will likely become the Republican Presidential nominee in 2024, without ever having to answer any questions about his administration’s disastrous pandemic response.
If there were any accountability, and any real journalists insisting on it, these would be some of the questions Trump would have to answer:
Should you have stuck with a public health response?
Before Covid, your Presidency was going pretty well. You had a good shot at winning another term. Would you agree that the pandemic pretty much reversed that?
Actually, it wasn’t just the pandemic. It was your administration’s response to the pandemic. The Democrats won by claiming you had botched the whole thing. They said hundreds of thousands of people died because you did not lock down soon enough and refused to wear a mask. They said the US should have behaved more like China than like Sweden. Do you agree?
A lot of Republicans now think you should have run the pandemic more like DeSantis did in Florida (even though they might not have said it at the time). It seems that before March 10th, 2020, you were planning to run it that way. And you were listening to your public health advisors from the CDC and NIH. Is that correct?
Why did you agree to spend trillions of dollars to keep everything shut down?
It was shocking when you seemed to pivot 180 degrees in just a few days, from saying that it would not be worse than a bad flu season, to announcing that we would throw everything we had at it, locking down the whole country — a devastating step that had never been taken before, for any reason, including war. It was especially surprising that you agreed to the economic shutdown. What made you change your mind?
Should you have allowed the security state to take over?
A lot of information has come out suggesting that you changed your mind because your National Security Council, and related military and intelligence leaders, told you the virus was a potential bioweapon that leaked from a Chinese lab. Is that what you were told? Did they tell you millions of people would die and you would be responsible, if you didn’t follow their plan?
In a Time Magazine article you were quoted saying “I can’t tell you that” when you were asked about why you thought the virus came from a lab in Wuhan. You said, “I’m not allowed to tell you that.” Who was not allowing you to speak openly about the possibility that it was a lab leak? Can you speak openly about it now?
Who made the decision in the middle of March 2020 to invoke the Stafford Act in all 50 states at the same time (which had never been done before), and to put FEMA in charge as the Lead Federal Agency for pandemic response, when FEMA had no warning and no experience in this area at all? Who decided to remove HHS from the role of Lead Federal Agency, which it was supposed to have according to every public health pandemic planning document before Covid? Did you make those decisions or did the NSC or other military or intelligence advisors tell you to take those steps?
Who was actually in charge?
When you brought Scott Atlas in, he advised you to open the country back up immediately. It seems like you really wanted someone in the White House with an opinion that was different from the one you were hearing in favor of lockdowns. But, for some reason, there was enormous resistance to bringing any experts in. There was even supposed to be a meeting at the end of March (long before Atlas arrived) with top epidemiologists that mysteriously got canceled. Why did you have so little control over who advised you about the pandemic? Why didn’t you follow the advice of Scott Atlas if, as he reported in his book, you pretty much agreed with him that the lockdowns were disastrous?
Most people think Fauci was in charge of the pandemic response. But in his book, Dr. Atlas reports that you said the main problem wasn’t Fauci, it was Deborah Birx. Is that because Birx was in charge of coordinating the NSC/DHS response, and Fauci was just a front to make it seem like a public health response?
A few months into the lockdowns, you sounded as if you had lost control of the situation, like in the tweet from May 18th, 2020 when you wrote in all caps: REOPEN OUR COUNTRY! You’d think if anyone could have ended the lockdowns, it would have been the President. But you seemed to feel helpless to reverse what was happening. Is that because there had been a sort of silent coup of the NSC and Department and Homeland Security?
Did the Deep State effectively stage a coup against your administration?
You recently said: “Either the Deep State Destroys America, or we destroy the Deep State.” Are you mad at all career bureaucrats, or frustrated because the National Security Council, DHS, and DoD seized control of the Covid response and you feel they did not behave in the best interests of all Americans?
Here’s my guess as to what the Deep State told you about Covid:“We, your biowarfare and bioterrorism experts, are hereby informing you that the novel coronavirus is a potential bioweapon that unfortunately leaked from a bioweapons lab into the civilian population in China. It sounds bad, but luckily we’ve spent many years planning for just such an eventuality. If you don’t do what we say, millions will die and you will be blamed. If you follow our plan, you might very well become the President who takes credit for a scientific miracle that will rid the world of pandemics forever.” Is this a fair representation of what you were told?
Did you participate in censorship and propaganda?
Were you aware of the massive censorship and propaganda that were happening to make people accept the lockdowns and vaccines? Do you feel like you were part of that campaign to convince people? Or do you feel like you were somehow forced to participate in it?
On March 7, 2020, Tucker Carlson came to warn you that “someone who works in the US government, a nonpolitical person with access to a lot of intelligence” told him the virus would kill millions of people if you didn’t lock down immediately and wait for vaccines. Do you know who warned Tucker and, most likely, urged him to warn you?
Did you engage in international coordination of the response?
Were you in touch with leaders of other allied countries to coordinate the response to the pandemic? It’s pretty astonishing how all our closest allies ended up doing exactly the same thing at the same time. If you were not the one who was coordinating with foreign leaders, were you aware of that type of coordination going on – especially with the UK, Canada, Australia, New Zealand, Israel, Germany, and other NATO allies?
What’s your position on the mRNA injections?
Were you told by your biodefense team that mRNA technology was a miraculous platform that would end the threat of pandemics, among other amazing accomplishments?
You have repeatedly expressed great pride in the “success” of Operation Warp Speed, which produced mRNA shots that were supposed to prevent Covid infection (as stated explicitly in the contracts signed by the DoD and the pharma companies under your administration). The injections were actually administered only once Biden became President, so one could argue that he was responsible for whatever happened after that. Would you agree that the Covid mRNA vaccines failed to accomplish what they were supposed to?
Florida has just passed a law banning the sale of lab-grown meat, even though such meat is perfectly safe and is an additional option for people who would like to eat meat without causing the death of animals. NBC News reports: Lab-grown meat, also known as cultivated meat, has attracted considerable attention in recent years […]
