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Indian Prime Minister Narendra Modi and his Hindu nationalist Bharatiya Janata Party view downgrading Kashmir’s status from a state in India to a union territory directly governed by New Delhi as a decisive blow to Pakistan’s claims over the disputed territory. But everyone stands to lose if regional tensions escalate further, starting with the 8 million residents of the Kashmir Valley now living under a total Indian security lockdown and communications blackout. China, more than any other player in this dangerous game of Risk, seems to understand that best.
Clashes between India and Pakistan over the Line of Control in Kashmir, the de facto border between Indian- and Pakistan-administered territories, have been so frequent that it is sometimes easy to overlook China’s role elsewhere in the region. But Beijing also has competing claims over parts of Kashmir and has contributed to long-running frictions. In recent years, however, it is the uneasy semi-détente between China and India over the Line of Actual Control—which separates Chinese-controlled territory from Indian-administered Kashmir—and the so-called McMahon Line on Kashmir’s northerly flank that has kept India-Pakistan tensions in check.
Previously subtle signs of China growing into its role as a regional arbiter in South Asia have become more pronounced recently. In June, Beijing publicly acknowledged that Foreign Ministry representatives met with leaders of the Afghan Taliban in China. The Chinese government has also held steady as a supporter of the Iran nuclear deal, a key plank of stability in the wider region. While Beijing protested India’s unilateral move in Kashmir last week, its response has so far been measured, despite having legitimate concerns about its own territorial claims.
At issue for China this time is what will become of the border area it calls Aksai Chin, a vast high desert that comprises part of a far western stretch of China’s troubled Muslim-majority Xinjiang region, and that India historically has laid claim to as part of Ladakh, a district of Indian-administered Kashmir. New Delhi’s decision to revoke Kashmir’s semiautonomous status would effectively appear to put India in charge of the fate of Aksai Chin, at least on paper.
Logic and restraint are likely to prevail, at least where China’s interests are concerned in Kashmir.
Beijing has challenged that very notion since the 1950s, including in a short war with India in 1962. China has repeatedly pressed India to drop its claim to Aksai Chin in exchange for Beijing’s agreement to cede another contested area along the McMahon Line known as Arunachal Pradesh to New Delhi. Despite small, occasional military incursions from both India and China, the two countries have signed on to a series of confidence-building measures since 1996 that have largely succeeded in dampening the risks of escalation.
Yet tensions still escalated in April 2015 when China’s Xi Jinping signed a $46 billion deal for several big-ticket infrastructure projects collectively called the China-Pakistan Economic Corridor, or CPEC, a portion of which runs through Kashmir. India sees the multifaceted project, which includes extensive new networks of highways, railways and energy pipelines across Pakistan and is part of China’s massive Belt and Road Initiative, as perhaps the greatest challenge to its influential position in South Asia.
Some analysts have argued that the joint Sino-Pak venture may fuel India’s fears of encirclement by a key economic competitor and a hostile rival. There may be a grain of truth in that assessment, but India’s claims to arguably more important maritime trade routes in the oil and gas rich Indian Ocean probably hold far more weight in its calculations. Plus, last year’s informal summit in Wuhan, China between Modi and Xi, after a different border spat near Bhutan, and the subsequent appointment of Indian and Chinese special envoys to deal with border disputes, seems to have helped reframe how both parties view the Kashmir question.
This may be one reason why Beijing seems to be flashing mixed signals in response to the latest flare-up in Kashmir. Within hours of the Indian Parliament’s decision on Aug. 5 to annul Kashmir and Jammu’s statehood, a Chinese Foreign Ministry spokesperson issued a statement saying that the move “hurt Chinese sovereignty by unilaterally changing domestic law.” Yet a week later, in a meeting with his Indian counterpart Subrahmanyam Jaishankar, Foreign Minister Wang Yi appeared to suggest that Beijing was prepared to exercise a kind of strategic restraint, framing the crisis as a matter to be settled by peaceful means. Although China’s statement was issued as Pakistan vowed to bring its fight to the U.N. Security Council, it seemed phrased to signal to India that Beijing would try to stand firm on prior confidence-building guarantees on Aksai Chin and build on the goodwill generated at Wuhan.
Nevertheless, China faces a different challenge from Pakistan, with Prime Minister Imran Khan pressing Islamabad’s claims to Kashmir through a combination of ethnonationalist polemics and diplomatic maneuvering. Khan’s stream of statements on Twitter about Kashmir have been full of hyperbole about India’s power grab and Hindu nationalism, which he has described as “inspired by Nazi ideology,” likening “Hindu Supremacy” to “the Nazi Aryan Supremacy.” Modi, for his part, has only added to the vitriol, vowing in an provocative speech on India’s Independence Day on Aug. 15 to restore Kashmir to its “past glory.”
Despite all the heated rhetoric, neither Pakistan nor India hold the kind of sway that China does at the U.N. Security Council. China’s chief counterparts, the United States and Russia, have indicated that they have little appetite for the kind of brief air war over Kashmir that erupted after Pakistani-backed militants mounted a suicide attack on an Indian military convoy in Kashmir in March. Plus, China has its hands full with Hong Kong. So there is little chance of Beijing backing Islamabad’s bid to get the U.N. involved. Instead, logic and restraint are likely to prevail, at least where China’s interests are concerned in Kashmir.
Candace Rondeaux is a senior fellow and professor of practice at the Center on the Future of War, a joint initiative of New America and Arizona State University. She has documented and analyzed political violence in South Asia and around the world for The Washington Post, International Crisis Group, the U.S. Special Inspector General for Afghanistan Reconstruction, the U.S. Institute of Peace and a host of international publications. Her WPR column appears every Friday.
GRACE1, previous track
16 minutes ago
Gibraltar’s Supreme Court ruled that the Iranian tanker Grace 1 is free to sail, hours after the US requested to detain the tanker [Jon Nazca/Reuters]
As reported in China Snapshot for the past few months, the protests in Hong Kong have arisen out of the concerns of residents: The protesters oppose Beijing’s encroachment on Hong Kong autonomy, want their local government to listen to public opinion, and wish to freely elect their leaders.
Yet on the mainland, the Chinese government has spun a different narrative with the help of state-controlled media, censors, and internet trolls. As the narrative goes, a small group of radical protesters, backed by the United States and other foreign governments, is wreaking havoc in the city and urging for an independent Hong Kong. The government has described the demonstrators’ recent airport protests as “near-terrorist acts.”
How does a country change the narrative and distort what is happening on the ground?
First, China’s so-called Great Firewall blocks online reports from foreign media. It blocks Chinese access to social media used internationally, and blocks any posts supportive of Hong Kong. Initially, Chinese media didn’t report on the Hong Kong protests, even as 2 million people peacefully took to the streets.
As protesters grew increasingly restless, citing unmet demands and excessive use of force by Hong Kong police, they began making more aggressive moves: They broke into and vandalized Hong Kong’s Legislative Council Complex, splashed ink on the Chinese emblem, threw the Chinese flag into the harbor, and in one case even threw gasoline bombs at the police. Chinese media quickly seized the opportunity to broadcast images of protesters disrespecting the government.
What the Chinese media left out: Police firing tear gas into a subway station. Peaceful protesters singing hymns. Pro-Beijing mobs attacking protesters. Police in riot gear chasing and beating protesters with batons. Undercover police slamming unarmed protesters to the ground, resulting in a pool of blood on the sidewalk.
Most notably, these media don’t explain why Hong Kong residents are protesting. For patriotic Chinese citizens who can access only Chinese news sources, the police look like heroes fighting a deranged group of China-hating separatists.
Second, the media has fueled conspiracy theories. Last week, pro-Beijing newspaper Ta Kung Pao published photos of pro-democracy activists Joshua Wong and Nathan Law meeting with U.S. diplomat Julie Eadeh. The newspaper also printed the names of Eadeh’s husband and young children. China’s official state broadcaster, CCTV, claimed Eadeh was an American “black hand” influencing the Hong Kong protests.
“I don’t think that leaking an American diplomat’s private information, pictures, names of their children—I don’t think that that’s a formal protest,” State Department spokeswoman Morgan Ortagus responded. “That is what a thuggish regime would do. That’s not how a responsible nation would behave.” She went on to say that it was normal for diplomats to meet with protesters and opposition parties in other countries.
Third: all-out lies. On Sunday, the most violent day of protests thus far, a police officer shot a beanbag round at protesters, blinding a woman in her right eye. The woman was providing first aid to the protesters. Yet CCTV said fellow protesters injured her. On the CCTV website, a reporter claimed to have captured a photo of the woman counting money and claimed she was responsible for paying protesters to join the demonstration.
The same day, the China Daily posted on Chinese social media a video of a protester with an airsoft gun and claimed it was an M320 grenade launcher used by the United States Army, reported The New York Times. In response to the Chinese media’s coverage, Chinese netizens are calling for their government to take stronger action against Hong Kong.
At times, the protesters’ own actions feed into the narrative Beijing is promoting. This week, protesters held sit-ins at the Hong Kong International Airport, causing airlines to cancel hundreds of flights. While the demonstration remained peaceful on Monday, it took a violent turn on Tuesday night as the massive group of protesters surrounded a man they accused of being an undercover cop. They tied his wrists together with plastic zip ties and kicked and punched him until he fainted.
When medics and police tried to get the injured man into an ambulance, protesters blocked their way. Police in riot gear arrived on the scene, rushing protesters and pushing them to the ground and beating them. At one point, a police officer pulled out a gun after a protester began beating him with the officer’s baton.
Protesters also surrounded a man who was wearing a yellow press vest and taking close-up photos of protesters. When protesters asked him to show his press pass, he refused and tried to leave, according to Hong Kong Free Press. Suspicious that he was a spy faking as a journalist, protesters tied his hands and feet and beat him. He was later also taken away by ambulance.
The man turned out to be Fu Guohao, a journalist for Global Times, a state-run nationalist tabloid. A clip of Fu yelling “I support Hong Kong police, you can hit me now,” went viral on WeChat, making him a hero in China. The overseas edition of the People’s Daily on Wednesday printed a front-page commentary stating, “Using the sword of the law to stop violence and restore order is overwhelmingly the most important and urgent task for Hong Kong!”
In the United States, Rep. Jim McGovern, D-Mass., the chairman of the Congressional-Executive Commission on China, has said he would introduce legislation to stop the sale of munitions and crowd control equipment to the Hong Kong police. The police have used at least 1,800 canisters of tear gas since the protests began.
“I am appalled and outraged by Hong Kong police and their escalating violence and brutality towards peaceful protesters and journalists,” tweeted McGovern. “I also call on the Trump administration to stop sending mixed signals on Hong Kong. Instead, they should suspend transfers of police and crowd control equipment to Hong Kong police. America must be on the side of those peacefully protesting for democracy and the rule of law.”
Luxury apology tour:
Chinese netizens are successfully pressuring luxury apparel brands like Versace, Coach, and Givenchy to apologize after the companies listed Hong Kong as a separate country from China on their T-shirts.
by Stephen Lendman
As the saying goes, if it walks, talks, and quacks like a duck, chances are it is one.
In calling for reunification of China in the early 1980s, then-leader Deng Xiaoping said Hong Kong and Macau could retain their own economic, financial and governmental systems, Taiwan as well under a “one country, two systems” arrangement.
The above would be something like what the US 10th Amendment stipulates, stating: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”
Each of the 50 US states has its own electoral system, governing procedures, and laws that may differ from federal ones.
China’s soft underbelly in Western-oriented Hong Kong left it vulnerable to what’s going on. US dirty hands likely orchestrated and manipulated pro-Western 5th column elements behind months of anti-Beijing protests.
Dubbed Occupy Central, China’s leadership is well aware of what’s going on and the high stakes. Beijing is faced with a dilemma.
Cracking down forcefully to end disruptive Hong Kong protests could discourage foreign investments. Letting them continue endlessly can destabilize the nation.
US war on China by other means aims to marginalize, weaken, contain, and isolate the country — because of its sovereign independence, unwillingness to bend to US interests, and its growing political, economic, financial, and military development.
China’s emergence as a world power threatens Washington’s aim to control other countries, their resources and populations worldwide.
Its successful economic model, producing sustained growth, embarrasses the US-led unfair, exploitive Western “free market” system.
The US eliminated the Japanese economic threat in the 1980s, a similar one from the Asian Tiger economies in the 1990s, and now it’s China’s turn to be taken down.
Its leadership understands what’s going on and is countering it in its own way. China is a more formidable and resourceful US adversary than earlier ones.
Its strategy includes taking a longterm approach toward achieving its objectives with plenty of economic and financial ability to counter US tactics.
It may become the first post-WW II nation to defeat Washington’s imperial game, making the new millennium China’s century in the decades ahead.
US strategies to control other nations include preemptive wars of aggression, old-fashioned coups, and color revolutions — what appears to be going on in Hong Kong.
This form of covert war first played out in Belgrade, Serbia in 2000. What appeared to be a spontaneous political uprising was developed by RAND Corporation strategist in the 1990s — the concept of swarming.
It replicates “communication patterns and movement of” bees and other insects used against nations to destabilize and topple their governments.
The CIA, (anti-democratic) National Endowment for Democracy (NED), International Republican Institute (IRI), National (undemocratic) Democratic Institute, and USAID are involved.
Their mission is disruptively subverting democracy and instigating regime change through labor strikes, mass street protests, major media agitprop, and whatever else it takes short of military conflict.
Belgrade in 2000 was the prototype test drive for this strategy. When subsequently used, it experienced successes and failures, the former notably in Ukraine twice — in late 2004/early 2005, again in late 2013/early 2014.
US color revolution attempts have a common thread, aiming to achieve what the Pentagon calls “full spectrum dominance” — notably by neutralizing and controlling Russia and China, Washington’s main rival powers, adversaries because of their sovereign independence.
Controlling resource-rich Eurasia, that includes the Middle East, along with Venezuelan world’s largest oil reserves, is a key US imperial aim.
Swarming tactics are being used in Kong Kong. According to RAND strategists John Arquilla and David Ronfeld, it’s war by other means.
It exploits the information revolution and social media to take full advantage of “network-based organizations linked via email and mobile phones to enhance the potential of swarming.”
In 1993, Arquilla and Ronfeldt explained that “warfare is no longer primarily a function of who puts the most capital, labor and technology on the battlefield, but of who has the best information” and uses it advantageously.
State-of-the art IT techniques use “advanced computerized information and communications technologies and related innovations in organization and management theory,” they explained.
Information technologies “communicate, consult, coordinate, and operate together across greater distances.”
Cyberwar today is what blitzkrieg was to 20th century warfare, involving “irregular modes of conflict, including terror, crime, and militant social activism.”
Both strategists believed swarming could “emerge as a definitive doctrine (to) encompass and enliven both cyberwar and netwar.”
They called swarming a way to strike from all directions in an overwhelming fashion, believing what works in combat theaters can be effective in waging war by other means in cities.
The strategy appears to be in play against China by targeting Hong Kong.
On August 12, Beijing’s official People’s Daily broadsheet said the city “is not and shall not be the frontline of US and China,” adding:
“Hong Kong has been rocked by chaos and violence for weeks, and the violence is getting more and more intense.”
“What is going on in Hong Kong? There is already evidence of interference by foreign forces.”
“As Chinese officials have pointed out, the situation in Hong Kong bears the features of a (US-orchestrated) color revolution.”
“US politicians have openly supported the unrest, and anti-China forces are working behind the scenes.”
“(T)he US government often uses democracy promotion to attack other countries, and China has always been a major target.”
“Some US politicians dream of making China look and act more like the United States. One reason we are seeing increased pressure on China is because those who have tried to change China over the years via other methods have failed and there is growing fear that China is getting too powerful, so the Uncle Sam will never miss any opportunity to undermine China.”
“…Hong Kong is Chinese territory. This means that the city is not and shall not be a playground for anti-China forces.”
“China is no longer a poor and weak country that cannot stand up to foreign interference.”
“The country has enough methods and strength to quickly quell the unrest and smash foreign plots when such actions are deemed necessary to protect national sovereignty and the prosperity and stability of Hong Kong.”
Beijing will deal with what’s going on in Hong Kong in ways it believes are most effective.
US destabilization and other hostile tactics make resolving major bilateral differences all the harder.
If Trump regime anti-China hardball tactics accelerate already weakening global economic conditions, including in the US, DJT could end up a one-term president.
Sino/Russian unity is also being strengthened to counter hostile US actions — a vital anti-imperial alliance US strategists fear.
My newest book as editor and contributor is titled “Flashpoint in Ukraine: How the US Drive for Hegemony Risks WW III.”
This article first published almost five years ago on October 1, 2014 is of particular relevance to an understanding of recent developments in Hong Kong.
Just as the US admitted shortly after the so-called “Arab Spring” began spreading chaos across the Middle East that it had fully funded, trained, and equipped both mob leaders and heavily armed terrorists years in advance, it is now admitted that the US State Department through a myriad of organizations and NGOs is behind the so-called “Occupy Central” protests in Hong Kong.
The Washington Post would report in an article titled, “Hong Kong erupts even as China tightens screws on civil society,” that:
Chinese leaders unnerved by protests elsewhere this year have been steadily tightening controls over civic organizations on the mainland suspected of carrying out the work of foreign powers.
The campaign aims to insulate China from subversive Western ideas such as democracy and freedom of expression, and from the influence, specifically, of U.S. groups that may be trying to promote those values here, experts say. That campaign is long-standing, but it has been prosecuted with renewed vigor under President Xi Jinping, especially after the overthrow of Ukrainian President Viktor Yanukovych following months of street demonstrations in Kiev that were viewed here as explicitly backed by the West.
The Washington Post would also report (emphasis added):
One foreign policy expert, who spoke on the condition of anonymity to discuss a sensitive subject, said Putin had called Xi to share his concern about the West’s role in Ukraine. Those concerns appear to have filtered down into conversations held over cups of tea in China, according to civil society group members.
“They are very concerned about Color Revolutions, they are very concerned about what is going on in Ukraine,” said the international NGO manager, whose organization is partly financed by the National Endowment for Democracy (NED), blamed here for supporting the protests in Kiev’s central Maidan square. “They say, ‘Your money is coming from the same people. Clearly you want to overthrow China.’ ”
Congressionally funded with the explicit goal of promoting democracy abroad, NED has long been viewed with suspicion or hostility by the authorities here. But the net of suspicion has widened to encompass such U.S. groups as the Ford Foundation, the International Republican Institute, the Carter Center and the Asia Foundation.
Of course, NED and its many subsidiaries including the International Republican Institute and the National Democratic Institute do no such thing as “promoting democracy,” and instead are in the business of constructing a global network of neo-imperial administration termed “civil society” that interlocks with the West’s many so-called “international institutions” which in turn are completely controlled by interests in Washington, upon Wall Street, and in the cities of London and Brussels.
|Image: While the Washington Post would have readers believe NED is in the business of promoting “freedom of expression” and “democracy” the corporate-financier interests represented on NED’s board of directors are anything but champions of such principles, and are instead notorious for principles precisely the opposite.|
The very concept of the United States “promoting democracy” is scandalous when considering it is embroiled in an invasive global surveillance scandal, guilty of persecuting one unpopular war after another around the planet against the will of its own people and based on verified lies, and brutalizing and abusing its own citizens at home with militarized police cracking down on civilians in towns like Ferguson, Missouri – making China’s police actions against “Occupy Central” protesters pale in comparison. “Promoting democracy” is clearly cover for simply expanding its hegemonic agenda far beyond its borders and at the expense of national sovereignty for all subjected to it, including Americans themselves.
In 2011, similar revelations were made public of the US’ meddling in the so-called “Arab Spring” when the New York Times would report in an article titled, “U.S. Groups Helped Nurture Arab Uprisings,” that:
A number of the groups and individuals directly involved in the revolts and reforms sweeping the region, including the April 6 Youth Movement in Egypt, the Bahrain Center for Human Rights and grass-roots activists like Entsar Qadhi, a youth leader in Yemen, received training and financing from groups like the International Republican Institute, the National Democratic Institute and Freedom House, a nonprofit human rights organization based in Washington.
The article would also add, regarding NED specifically, that:
The Republican and Democratic institutes are loosely affiliated with the Republican and Democratic Parties. They were created by Congress and are financed through the National Endowment for Democracy, which was set up in 1983 to channel grants for promoting democracy in developing nations. The National Endowment receives about $100 million annually from Congress. Freedom House also gets the bulk of its money from the American government, mainly from the State Department.
|Image: US Senator John McCain on stage in Kiev, Ukraine cheerleading US
funded sedition in Eastern Europe. In 2011, McCain would famously taunt
both Russia and China that US-funded subversion was coming their way.
“Occupy Central” is one of many waves that have hit China’s shores since.
Pro-war and interventionist US Senator John McCain had famously taunted both Russia’s President Vladimir Putin and President Xi Jinping’s predecessor in 2011 that the US subversion sweeping the Middle East was soon headed toward Moscow and Beijing. The Atlantic in a 2011 article titled, “The Arab Spring: ‘A Virus That Will Attack Moscow and Beijing’,” would report that:
He [McCain] said, “A year ago, Ben-Ali and Gaddafi were not in power. Assad won’t be in power this time next year. This Arab Spring is a virus that will attack Moscow and Beijing.” McCain then walked off the stage.
Considering the overt foreign-funded nature of not only the “Arab Spring,” but now “Occupy Central,” and considering the chaos, death, destabilization, and collapse suffered by victims of previous US subversion, “Occupy Central” can be painted in a new light – a mob of dupes being used to destroy their own home – all while abusing the principles of “democracy” behind which is couched an insidious, diametrically opposed foreign imposed tyranny driven by immense, global spanning corporate-financier interests that fear and actively destroy competition. In particular, this global hegemon seeks to suppress the reemergence of Russia as a global power, and prevent the rise of China itself upon the world’s stage.
The regressive agenda of “Occupy Central’s” US-backed leadership, and their shameless exploitation of the good intentions of the many young people ensnared by their gimmicks, poses a threat in reality every bit as dangerous as the “threat” they claim Beijing poses to the island of Hong Kong and its people. Hopefully the people of China, and the many people around the world looking on as “Occupy Central” unfolds, will realize this foreign-driven gambit and stop it before it exacts the heavy toll it has on nations that have fallen victim to it before – Libya, Syria, Ukraine, Egypt, and many others.
[“Opioid Abuse” is the red herring that will fully empower the Medical Dictatorship (Govt-controlled doctors creating un-Constitutional authority to eliminate the right to privacy in all American adults. Doctors gave-up their right to practice medicine when they gave up before the Govt onslaught which allowed bureaucrats to police the treatment of pain).]
It’s time for doctors to start asking every patient, every time: Have you engaged in any illicit drug use?
A draft report issued Tuesday by the U.S. Preventive Services Task Forcerecommends that all U.S. adults be screened for illicit drug use as long as their doctors can do so accurately and, when abuse is detected, offer their patients effective treatment or refer them to someone who can.
Questions about drug use should not only cover the possibility that a patient is taking illegal street drugs like cocaine or heroin, the task force said. They should also explore whether a patient might be sneaking pills from a family member’s pain medication or getting a boost from stimulants prescribed for a child with attention-deficit/hyperactivity disorder.
The task force has long advised doctors to query American adults — and in some cases adolescents — about their drinking and smoking habits. If the new recommendation is adopted, drug abuse would join the list of risky behaviors to be diagnosed and often treated by primary care doctors.
At a time when addiction has become a leading cause of disability in the U.S. and drug poisonings have become the No. 1 cause of injury-related deaths, some say the panel’s advice is long overdue.
“We’ve been doing this for almost a decade in my office,” said Dr. Gary LeRoy , a staff physician at the East Dayton Health Clinic in Dayton, Ohio, and president-elect of theAmerican Academy of Family Physicians .
The draft recommendation leaves no doubt about the extent of drug abuse in America, he said. A nationwide survey conducted in 2017 by the Substance Abuse and Mental Health Services Administration found that 30.5 million people — roughly 11.5% of American adults — said they had used illicit drugs in the past month.
“All of us should be keenly aware that on average, one in 10 of our patients are doing drugs — whether we ask them or not — and we’re not going to cause someone to use illicit drugs because we ask the question,” LeRoy said. “When you create an atmosphere of trust where you have safe conversations, they appreciate that you ask.”
The task force, a group of experts who advise the federal government on disease prevention, did not extend its recommendation to adolescents ages 12 to 17. Panel members said they could not find enough credible scientific evidence to offer guidance for this age group, and they called for more research on teen drug abuse and treatment. (The American Academy of Pediatrics currently recommends screening all adolescent for substance use .)
It’s been more than a decade since the task force last deliberated on the wisdom of population-wide screening for illicit drug use.
In 2008, a year in which 36,450 Americans died of drug overdoses, the panel did not see a compelling case for population-wide screening. This year, the death toll from drug abuse could wind up being more than twice as high as it was in 2008.
In 2017, the most recent year for which definitive statistics are available, drug overdoses claimed 70,237 lives in the United States, according to the Centers for Disease Control and Prevention. As opioid addiction burgeons and more users are exposed to the powerful synthetic opioid fentanyl, overdose deaths are widely expected to climb even higher in 2018 and 2019.
That context “of course matters,” said behavioral medicine specialist Karina Davidson, who co-chaired the task force’s panel on illicit drug-use screening. But she said the recommendation was prompted by other circumstances as well.
Since 2008, for instance, drug-abuse specialists have devised brief screening mechanisms that help identify illicit drug use and those at risk for it, Davidson said. In addition, she added, a growing stack of research studies has shown that treatments for drug-use disorder and addiction — including behavioral interventions and pharmacological therapies — are effective in helping patients quit or cut back.
That evidence of effectiveness is a key change from earlier years, said Dr. Carol Mangione , a UCLA internal medicine specialist who co-chaired the task force committee that drafted the new recommendation.
“We don’t want to screen for something unless we know there’s an effective treatment,” she said. “If you don’t have a treatment that’s effective for people who screen positive, you haven’t really helped.”
Still, effective treatments remain woefully underused, experts say.
The drug regimens that are most useful for combating addiction — a list that includes naltrexone, methadone and buprenorphine — are rarely offered by primary care physicians, who must contend with a gauntlet of paperwork and training to prescribe them. And many addiction specialists, insurers and state legislatures are suspicious of treatments that use prescription opiates to wean people off illicit opioids.
The new recommendation could help change that, Davidson said.
If doctors know they will be expected to ask about and address their patients’ illicit drug use, more of them will probably do the work necessary to prescribe anti-addiction drugs, and more of them will develop relationships with other care providers to whom they can refer patients for treatment, she said.
That process seems to be underway already, Mangione said. At a recent meeting of the Society for General Internal Medicine, she said, a workshop on medication-assisted treatment for addiction was standing-room only.
“We’re very motivated to use these treatments and to pair them up with individual and group therapy,” she said.
LeRoy acknowledged that some doctors are wary of raising the subject. But when they start to ask the question, and to help patients who acknowledge illicit drug use, they quickly see that many of their long-term patients have been struggling, he said.
“They say, ‘Oh, I had no idea I already had these people in my practice,’” LeRoy said. “ ‘When I started asking these questions and providing the service, they came out of the woodwork.’”
Patients, too, could feel less stigma about drug use, and that might make them more likely to acknowledge they might need help, Davidson said. For some patients with problematic drug use, that earlier catch could head off addiction or even death.
“If everyone is asked, we can get to some people who are at a less-severe stage in their drug use, not all the way into addiction,” she said.
The draft recommendation statement is posted on the U.S. Preventive Services Task Force website, along with a review of the research on which the recommendation is based. The public is invited to submit comments until Sept. 9; after those are considered, the advice may be modified and finalized.