Politicians have long known that how you frame a policy issue can determine its fate.

Consider how the term “weaponizing the First Amendment” frames the issue of speech on social media. Kara Swisher, a reporter and opinion writer at the New York Times, wrote yesterday that “Facebook, as well as Twitter and Google’s YouTube, have become the digital arms dealers of the modern age.” She continues,

They have weaponized social media. They have weaponized the First Amendment. They have weaponized civic discourse. And they have weaponized, most of all, politics.

Supreme Court Justice Elena Kagan also recently accused a majority of colleagues of “weaponizing the First Amendment.”

Let’s trace the implications of the term “weaponize” for free speech. The American Heritage Dictionary offers several definitions of “weaponize”:

To supply with weapons or deploy weapons in…

To equip (a missile or other delivery system) with an explosive or other weapon.

To place or mount (an explosive or nuclear device, for example) on a missile or other delivery system.

To produce or refine (a substance or biological agent, for example) for use as a weapon.

To deploy missiles or other delivery systems equipped with weapons.

Notice the connotation of violence? That’s important because in the United States speech is free of the government censor up to direct incitements to violence. The verb “weaponize” invites readers to see some speech on the internet as something like violence. Once that connection is made, censoring the speech becomes more acceptable, perhaps even required.

Kara Swisher’s column seeks to persuade Mark Zuckerberg, not justices on the Supreme Court. Facebook is not covered by the First Amendment. Swisher is inviting Zuckerberg to see some speech on Facebook as a kind of violence. Framed that way, such speech has no place on Facebook or anywhere, really. Zuckerberg can certainly remove it from Facebook; Congress could act if he does not. After all, Congress has the power to punish violence.

So next time you see the term “weaponize” think about the implications of the word for other people’s speech (it’s always other people’s speech). For those people whose speech is being equated with violence, the implications could be dire.

This post follows my post yesterday about Facebook taking down fake accounts that “helped promote more than three dozen events in the last 15 months, most of them protesting the policies of President Donald Trump or promoting left-leaning causes.” The posts, thought to be supported by Russian operatives, “sought to work alongside legitimate groups organizing rallies and protests in the U.S.” 

So this is not just about the Russians. Americans also associated with the pages for political reasons. One page drew 84,000 likes. Other similar groups, supported by Americans, associated with, and spoke with the pages. (Their queries were not answered). 

As I wrote yesterday, Facebook was well within their rights to take down the pages. They did so because the accounts were fake and thus violated their community standards. Facebook would have had the right to take the pages down because of the Russian support or for “protesting the policies of Donald Trump or promoting left-leaning causes.” But to have the right is not the same as exercising it. Facebook wisely stayed away from the Russian issue and of course, did not remove the pages because of their content. 

But a fact remains: Facebook deprived Americans of their ability to associate with or speak with others for political purposes. It’s not a good look even though the neutral application of community standards does justify the takedown. 

Set Russia aside for a moment and consider the American part of the story. The deleted pages said things some Americans wanted to hear and supported. Members of Congress might find such speech “divisive” or “disinformation.” Apparently some Americans disagreed: they presumably saw the speech as informative and helpful.

In the United States, by culture and by law, we have free speech so people can learn about and evaluate politics and much else. The people who saw the deleted pages seemed to have engaged and assessed the material. “It was the truth about our people,” Victor Perez, a construction worker in Salt Lake City said of a deleted page that, the Wall Street Journal reports, “used divisive memes to promote Native American and Hispanic culture.” 

Yet the same article quotes experts who say allowing such pages will push the Victor Perezs of the world toward extremism while undercutting trust in “legitimate political activists.” In other words, speech online needs to be managed or really bad things will happen. 

But we have such a management system already. 

Individuals have the right and responsibility to inform themselves critically about politics and much else. They have the right to associate with one another to discuss ideas and to persuade others. They can reject bad ideas. Indeed, we trust that they will. Do people actually believe in these ideals? 

The Constitution prevents the government from improving social outcomes by preventing speech and association. Facebook has a right to govern its platform, but we might expect they will only remove users who violate neutral rules. After all, Mark Zuckerberg endorses the American view of free speech. 

The rest of us should stop expecting internet intermediaries like Facebook to be guardians of truth and wholesome speech.

The usual narrative is that Democrats support consumer protections and Republicans oppose them. Today’s short-term plans final rule flips that narrative: Republicans are expanding consumer protections, and Democrats are opposing them.

Today’s rule reverses a 2016 Obama rule. The Obama rule reduced consumer protections in short-term plans by exposing sick patients to medical underwriting. Before that rule, consumers could purchase short-term plans that lasted 12 months. If they developed a serious illness, their plan could cover them until the next ObamaCare open enrollment period, when they could purchase coverage without medical underwriting. The Obama rule restricted short-term plans to 3 months. It prohibited “renewal guarantees” that protect enrollees who fall ill from medical underwriting when they purchased a new short-term plan. As a result, the Obama rule left short-term plan enrollees who got sick with no coverage for up to 9 months: those who purchased a plan in January, and developed a serious illness in February, would lose their coverage at the end of March, and have no coverage until the following January. (Source: NAIC) This was by design: the Obama administration wanted to expose sick people in short-term plans to medical underwriting and lost coverage as a way of forcing consumers to buy ObamaCare coverage instead. That’s at least a little messed up.

Today’s rule allows short-term plans to last 12 months and offer renewal guarantees. It therefore allows short-term plans to protect the sick from medical underwriting for an additional 9 months—indeed, “issuers may offer coverage under a short-term, limited-duration insurance policy for up to a total of 36 months, without any medical underwriting or experience rating beyond that completed upon the initial sale of the policy”—and allows renewal guarantees to protect them from medical underwriting indefinitely. Protecting the sick from medical underwriting has long been a goal of Congress.

So, to recap, Republicans are expanding consumer protections, and Democrats are opposing an expansion of consumer protections.

Weird, isn’t it?

I have written here and here about how patients have become the civilian casualties of the misguided policies addressing the opioid (now predominantly fentanyl and heroin) crisis. The policies have dramatically reduced opioid prescribing by health care practitioners and have pressured them into rapidly tapering or cutting off their chronic pain patients from the opioids that have allowed them to function. More and more reports appear in the press about patients becoming desperate because their doctors, often fearing they may lose their livelihoods if they are seen as “outliers” by surveillance agencies, under-treat their pain or abruptly cut them off of their pain treatment regimen.

A story in the July 23, Louisville (KY) Courier Journal illustrates the harm this is causing in Kentucky. “Doctors say the federal raids on medical clinics lead to unintended consequences — patients thrust into painful withdrawals and left vulnerable to suicide or dangerous street drugs,” states the article. Dr. Wayne Tuckerson, President of the Greater Louisville Medical Society, said, “[When investigators] go in with a sledgehammer and shut down a practice without consulting community physicians, suddenly we have patients thrown loose.” He went on to say, “Docs are very much afraid when it comes to writing pain medications…We don’t want patients to become addicted. And we don’t want to have our licenses — and therefore our livelihoods — at stake.” And if pharmacists in the area learn of a police raid or investigation of a medical practice—regardless of the outcome of that investigation—many of them refuse to fill legal prescriptions presented by patients of those practitioners.

Last week Oregon regulators announced plans for a “forced taper” of chronic pain patients in its Medicaid system. This contradicts and is much more draconian than the recommendations of the 2016 guidelines issued by the Centers for Disease Control and Prevention, which in turn have been criticized as not evidence-based. The Oregon Health Evidence Review Commission announced: 

The changes include a forced taper for all chronic pain patients on opioids (within a year), no exceptions. Opioids will be replaced with alternative treatments (cognitive behavior therapy (CBT), acupuncture, mindfulness, pain acceptance, aqua therapy, chiropractic adjustments, and treatment with non-opioid medications, such as NSAIDS, Acetaminophen).

This proposal has sparked an outcry from patients and patient advocacy groups in Oregon. While this policy proposal only applies to Medicaid patients, they fear it will soon become the standard adopted by all third-party payers in the state.

University of Alabama Medical School Associate Professor Stefan Kertesz, an addiction medicine specialist at the Birmingham VA Medical Center, tweeted in reaction to this proposal:

I cannot imagine a more violent rejection of the CDC Guideline on Prescribing Opioids of 2016 than the plan current before Oregon Medicaid : forced taper to 0 mg of all opioid receiving pain patients.

These policies are based on the false narrative that the overdose problem is primarily the result of doctors prescribing opioids to their patients in pain and getting them hooked. In fact, the problem has always been a product of drug prohibition—non-medical users accessing opioids on the black market. To illustrate, an often-overlooked study published in the American Journal of Psychiatry in 2009 followed more than 27,000 OxyContin addicts entering rehab programs from 2001–2004. It found 78 percent said they never had obtained a prescription of OxyContin for any medical reason, 86 percent said they used the drug because they liked the “buzz” or “high,” and 78 percent reported prior treatment for substance abuse disorder.

There have been well-documented cases of unscrupulous doctors teaming up with dishonest pharmacists to operate “pill mills”—gaming the third-party payment system to receive compensation for running drug-dealing operations. But these bad apples have largely been rolled up by law enforcement and represented an exception to the rule of how doctors treat pain. Nevertheless, these stories continue to feed the narrative.

Dr. Charles Argoff, a professor of neurology at Albany Medical College and Director of its Comprehensive Pain Center recently surveyed colleagues in a report for the medical education website Med​scape​.com entitled “Readers Respond: Stop Stigmatizing Opioids.” The majority of clinicians dealing with pain bemoan the hysteria driving the governments’ response to the overdose problem. One clinician emphasized, “Dependence is the rule, addiction is the exception.” Another complained about the “misinformation, distortion of evidence-based research, political influence, and even mainstream media sensationalism-style reporting, which together has deteriorated to such an extent that it is beyond belief…A person should review all available information that is opposing the arrogantly forgotten patient.”

Dr. Argoff concluded his survey with the following comment:

In summary, I hope these comments further epitomize and suggest how complicated opioid therapy is. But what I am struck by is how much these comments point to identifying that subset of individuals for whom these medications are successful and also outlining the risk of so many other medical treatments, both interventional and noninterventional, that we consider for our patients with chronic pain.

Meanwhile the civilian casualties mount. Dr. Thomas Kline, a physician in North Carolina, is maintaining a growing list of patients who commit suicide after being cut off from their pain medication. Expect the deaths—of patients as well as non-medical users—to continue until policymakers come to the realization that the root cause of the problem is drug prohibition.

Last week, the Washington Post picked up on an article in Police Quarterly that showed clearance rates for property and violent crimes increased in Colorado and Washington following their legalization of marijuana for recreational purposes. The clearance rate is the percentage of reported crimes that result in an arrest for those crimes. These data support the notion that Cato and other pro-legalization advocates have been saying for years: if the government ends the drug war, it frees up police resources to solve other crimes and perform other functions more necessary to public well-being than prosecuting drug crimes. Of course, these data are not conclusively causal and different agencies may react differently to legalization in their jurisdictions, but they are a good sign for reform that academics can measure as more states legalize.

On a related note, my colleague Jeff Miron published a piece today examining the budgetary impact of ending drug prohibition. You can find that here.

A few weeks ago, President Trump surpassed his 500th day in office. That’s a good vantage point to appraise his economic policies to Make American Great Again.

Over at the Library of Economics and Liberty’s Econlog, I offer my assessment. It’s not good.

This may seem surprising, given current economic conditions. But economic policy isn’t merely about the current moment, but predominantly about improving economic conditions long-term. Aside from a couple of provisions in the December 2017 tax law, President Trump has done precious little in that regard and much to harm the economy long-term, from borrow-and-spend fiscal policy, to disastrous trade and immigration policies, to disinterest in serious regulatory reform, to his refusal to face the country’s dreary long-term fiscal challenges.

From my conclusion:

MAGAnomics appears to be little more than an impulsive dislike of free trade and immigration, a hazy desire for less regulation, disinterest in (or perhaps a lack courage to face) the nation’s long-term fiscal problems, and a desire to temporarily lower taxes without making the hard choices necessary to fiscally balance those cuts and make them enduring. In other words, MAGAnomics is a slogan supporting a few weak and many harmful initiatives, not a serious collection of policies thoughtfully designed to strengthen the nation’s economic health.

Take a look and see if you agree.

As a physician licensed to prescribe narcotics, I am legally permitted to prescribe the powerful opioid methadone (also known by the brand name Dolophine ) to my patients suffering from severe, intractable pain that hasn’t been adequately controlled by other, less powerful pain killers. Most patients I encounter who might fall into that category are likely to be terminal cancer patients. I’ve often wondered why I am approved to prescribe methadone to my patients as a treatment for pain, but I am not allowed to prescribe methadone to taper my patients off of a physical dependence they may have developed from long-term opioid use, so as to help them avoid the horrible acute withdrawal syndrome. I am also not permitted to prescribe methadone as a medication-assisted treatment for addiction. These last two uses of the drug require special licensing and permits and must comply with strict federal guidelines. 

The synthetic opioid methadone was invented in Germany in 1937. By the 1960s, methadone was found to be effective as medication-assisted treatment for heroin addiction, and by the 1970s methadone treatment centers were established throughout the US, providing specialized and highly structured care for patients suffering from Substance Abuse Disorder. The Narcotic Addict Treatment Act of 1974 codified the methadone clinic structure. Today, methadone clinics are strictly regulated by the Drug Enforcement Administration, the National Institute on Drug Abuse, the Substance and Mental Health Services Administration, and the Food and Drug Administration. These regulations establish guidelines for the establishment, structure, and operation of methadone clinics, in most cases requiring patients to obtain their methadone in person at one fixed site. After a period of time, some of these patients are allowed to take methadone home from the facility to self-administer while they remain closely monitored. This onerous regulatory system has led to an undersupply in methadone treatment facilities for patients in need. Furthermore, the need for patients to travel, often long distances, each day to the clinic to receive their daily dose has been an obstacle to their obtaining and complying with the treatment program.

Earlier this month addiction specialists from the Boston University School of Medicine and Public Health and the Massachusetts Department of Public Health argued in the New England Journal of Medicine that community physicians interested in the treatment of Substance Abuse Disorder should be allowed to prescribe methadone to their patients seeing them in their offices and clinics. Doctors have been allowed to prescribe the opioid buprenorphine for medication-assisted treatment of addiction for years, and in recent years nurse practitioners and physicians’ assistants have been able to obtain waivers that allow them to engage in medication-assisted treatment as well.

The authors noted that methadone has been legally prescribed by primary care providers to treat opioid addiction in other countries for many years— in Canada since 1963, in the UK since 1968, and in Australia since 1970, for example. They state, 

Methadone prescribing in primary care is standard practice and not controversial in these places because it benefits the patient, the care team, and the community and is viewed as a way of expanding the delivery of an effective medication to an at-risk population.

Policymakers serious about addressing the ever-increasing overdose rate from (mostly) heroin and fentanyl afflicting our population should take a serious look at reforming the antiquated regulations that hamstring the use of methadone to treat addiction.