Drug Control vs. Pain Control

A crackdown on opioid prescriptions will hurt patients.

Last week, unveiling a plan to curtail "diversion" of opioid painkillers, Obama administration officials said they aim to "strike a balance between our desire to minimize abuse of prescription drugs and the need to ensure access for their legitimate use." This balance will never be achieved because the two goals are fundamentally irreconcilable.

Since pain cannot be verified objectively, there is only so much a conscientious doctor can do to make sure a patient is not a malingerer, an addict, or a drug dealer. At a certain point, he has to choose between trusting his patients and helping the government enforce its arbitrary dictates regarding psychoactive chemicals. If he sides with his patients, he risks his license, his livelihood, and his liberty. If he sides with the government, it is inevitable that some patients will suffer needlessly.

Doctors are less inclined to prescribe opioids, even to legitimate patients in horrible pain, when they worry that regulators, police, and federal drug agents are looking over their shoulders, ready to second-guess every decision and transform honest mistakes or medical disagreements into felonies. Every additional layer of scrutiny only compounds the drug war's chilling effect on pain treatment.

That is one of the problems with the computerized prescription drug monitoring programs (PDMPs) that the Obama administration wants every state to establish. The benefits of such programs, which 35 states have implemented so far, are questionable. A recent study by researchers at the U.S. Centers for Disease Control and Prevention found that "PDMP states did not do any better than non-PDMP states in controlling the rise in drug overdose mortality from 1999 to 2005."

To the extent that PDMPs do succeed in changing doctors' prescribing practices, the impact won't be limited to nonmedical users. Data from the National Survey on Drug Use and Health indicate that 70 percent of nonmedical users get painkillers from friends or relatives with prescriptions. Cutting off these sources through aggressive monitoring is bound to hurt many legitimate patients.

The same thing is true of the Obama administration's proposed requirement that doctors be barred from prescribing narcotic painkillers until they receive "training on the importance of appropriate prescribing and dispensing of opioids to prevent adverse effects, diversion, and addiction." First, the training mandate (which would require new legislation) would reduce legitimate patients' access to painkillers by reducing the number of physicians authorized to prescribe them. Second, the focus of the training would tend to make doctors even more suspicious of patients seeking pain treatment.

To justify a crackdown that will be effective only if it hurts people in pain, the Office of National Drug Control Policy says we are experiencing a "prescription drug abuse crisis" that amounts to an "epidemic." Although there is little evidence of such an epidemic in the federal government's own survey data, the number of fatal overdoses involving opioid analgesics nearly quadrupled between 1999 and 2007. Meanwhile, the amount of opioids prescribed per person has increased by an even larger percentage, meaning the risk of overdose is smaller today than it was a decade ago.

These overdose deaths mainly result from careless decisions by nonmedical users who either take too much or mix narcotic painkillers with other depressants. All the talk of an "epidemic," which brings to mind a deadly microbe that infects people who have no choice in the matter, tends to conceal this reality. The New York Times says OxyContin "hurtled through" an Ohio town, as if it were a tornado indiscriminately wreaking havoc instead of a drug deliberately taken by people who like its psychoactive effects.

By contrast, people who suffer from severe chronic pain as a result of car crashes, botched surgeries, or degenerative conditions do not choose to be in that situation. It's bad enough that they are forced to beg government-appointed gatekeepers for relief. They should not be punished further because of other people's reckless choices.

Jacob Sullum is a senior editor at Reason and a nationally syndicated columnist.

© Copyright 2011 by Creators Syndicate Inc.

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  • Suki||

    Good morning RACIST reason.

  • ||

    We will never achieve the balance because for some people being an addict is preferable to living without pain killers. Part of the problem is we have bought into the rehab industry's propaganda that nothing is worse than being an "addict". Bullshit, there are lots of fates worse than being an addict. If your choice is to be a functional addict or be in constant debilitating pain every day, being an addict is the best of bad options. For some reason we as a society have a hard time facing that reality.

  • Fist of Etiquette||

    We as a society have a harder time empathizing than we do succumbing to brainwashing. For so long drug use has been demonized through education as well as pop culture that the general populace has accepted that not only recreational drug use is bad.

    We as a society are sociopathic and will seemingly never understand it's better for our sensibilities to be assaulted by painkiller abuse than it is for anyone to suffer needlessly, until each of us is need of chronic pain management ourselves.

  • Nomic||

    A nice guy I used to work with has degenerative back problems. The pain associated with it was clearly horrible. Because of that, he had taken enough pain killers (like fentanyl) that at age 35 he was opioid resistant. His doctor prescribed a "lollipop" form of a med to lower his resistance. Unlike pills, he could adjust the dose on the fly just by taking it out of his mouth until he needed more. While on the lollipop, he was great to work with, organized, timely & creative.
    FDA labeling lists it for use by cancer pain patients, not for back pain patients, so they had to put him back on the pill form. Same drug, less control. Yeah, big help. Now he sits home on welfare alternating between being in horrible pain or too stoned out of mind to do the work he loves.
    The FDA forces the abuse of the man and the drugs. And I lost a good friend and graphic artist in the process.

  • ||

    You worked with Kojak?

  • rather ||

    Good morning RACIST SEXIST reason.

  • ||

    So drugs are now sexist?

  • rather ||

    John, it was a little thing called a joke :-)

  • rather ||

    but ya, Reason is monomaniacal

  • ||

    Monomaniacal. That is a good word.

  • ||

    Monomania is pretty much JG Ballard's favourite word. His books are worth checking out!

    Empire of the Sun is probably the easiest book to start with (and is 10^6x better than the film).

  • ||

    I will have to check that out. I liked the movie. So I bet I would love the book.

  • ||

    Cool. It's a fictionalised biography that I really enjoyed.

    The passage where one of the starving characters describes the extraordinary, intoxicating taste of animal fat is one of my all time favourites.

  • rather||

    I love the imagery in Empire of the Sun

  • ||

    I know. I was just being flippant.

  • Barack Obama||

    Let me be clear.

    Flippancy may be indicative of opioid dependency.

  • Ta-da-la-fil||

    cockiness isn't diagnostic of opioid dependency-wrong brain

  • Suki||

    +1

  • ||

    This strikes me more and more as a problem of framing the debate. We have allowed the buttinskis to scare us with imagined tidal waves of drug addicts for decades. It is time we put it differently;

    The Drug warriors are willing to risk condemning innocent people to unending pain to prevent goddamned fools from hurting themselves of their own will. This is idiotic at best, and barbaric at worst. It is indefensible, if we insist on framing it this way.

    When the Buttinskis tell us "But unless we clamp down on (scary-drug-of-the-month), peoples' lives will be ruined!". We need to answer "So?"

  • ||

    It all goes back to our inability to understand that there are no perfect options. If you let people who need pain killers get them, people who don't need them and just want to abuse them will get them to. The fact that that is the price we have to pay to keep people from living in horrible pain is something no one is willing to accept. They instead live in a fantasy world where we can keep the "bad people" from getting them and also help people.

  • Matrix||

    Because.. you have to be a bad person to want to use painkillers for recreation.

  • ||

    Exactly. I couldn't care less if people use them for recreation. That is their business. Who am I to say that they have to face life sober?

    The public has several levels of neurosis on this subject. And the complete inability to admit that perhaps it might be okay to take a drug for fun is probably the deepest and most intractable one.

  • Heroic Mulatto||

    Exactly. I couldn't care less if people use them for recreation. That is their business. Who am I to say that they have to face life sober?

    But the children, John, the children.

  • fish||

    It's more convincing if you think about Helen Lovejoy when you type

  • Tool||

    Why can't we not be sober?
    I just want to start this over.
    Why can't we dream forever?
    I just want to start things over.

  • EscapedWestOfTheBigMuddy||

    Amateur.

    Warty would have given us a link.

  • Juanita||

    Especially when we accept alcohol use for fun.

  • ||

    And note I put "bad people" in scare quotes for a reason. I didn't mean to imply I agree with that just that that is what many people think.

  • LarryA||

    If you let people who need pain killers get them, people who don't need them and just want to abuse them will get them to.

    And if you don’t let people who need pain killers get them, people who don't need them and just want to abuse them will still get them.

  • ||

    true. also people's responsiveness to opioids varies GREATLY from person to person. some people get good relief with low dose hydrocodone. others need high dose oxycodone (roughly twice as strong on mg per mg basis).

    i emphathize with dr's because they are afraid of DEA scrutiny but people should not be forced to endure pain because OTHER people abuse opioids.

  • Matrix||

    after getting my wisdom teeth pulled, the doc wrote a prescription for Lorcet Plus (hydrocodone + tylenol). Made me a little nauseous, and occasionally got me feelin' allllright. Week later, still in major pain, so he gave me Percocet. No nausea, and even more feeling rather high. But those opioids sometimes make me really loopy. Other times I feel level. Glad to get off the stuff once my pain meds wore off.

  • ||

    The VA has had me on morphine and Oxycodone for 16+ years for spinal injury. I now take 320mg daily of morphine and 80mgOxy, more than enough to kill most people. I'm developing a tolerance AGAIN and will need a dosage increase unless the attempt to overthrow our medical cannabis law fails and I can kick the narcotics at last.

  •  ||

    They aim to "strike a balance"

    Uh oh.

  • EscapedWestOfTheBigMuddy||

    This.

    That phrase is always a prelude to authoritarian shitheads sticking their foul fingers where they do not belong.

  • Sabrina||

    I never had a problem getting a prescription from my doctor, it was the pharmacy and the insurance company who made me feel like a criminal for needing oxycontin. Drop off the prescription, get your license photocopied, the pharmacy needs confirmation of the prescription faxed over from your doctor, then they call the insurance company, and then MAYBE the pharmacy would have enough in stock to fill the prescription (no partial fills allowed on opiods). But then, after all that, they'd let anyone pick it up who knew my address.

  •  ||

    I have almost the same problem buying beer in New York.

  • Nomic||

    And Virginia.
    I get carded even though I have the gray to show I've been legal to drink for 30 years.
    I always feel like they're asking me for proof I can drink and drive.

  • JCR||

    Or buying beer at a grocery store in PA.

  • ||

    i never had a problem with pharmacy or insurance when i had oxycontin scripts. heck, they didn't even ask for IDENTIFICATION.

  • Blue Privilege||

    I wonder how that could be?

  • ||

    i didn't go in uniform and they don't know i'm a cop, if that's what yer implying.

    i've gotten such scripts filled at several different places. as long as you have an insurance card, they don't ask for ID.

    if you want ephedrine though. it's MANDATORY ID and signature

  • WTF||

    OT - More hijinks at the University of Missouri.

  • sarcasmic||

    A coworker of mine has serious back issues and carries around with him a half dozen bottles of pills.
    They range from oxy to methadone.
    When things get really bad he goes to the hospital to get a morphine drip.

    This same guy praises the Drug War and looks down on users of unapproved chemicals as subhuman.

  • Rich||

    *My* drugs are good/necessary/a miracle/legitimate and *your* drugs are evil/recreational/a scourge/illegal.

  • Robert||

    Yeah, those were the good old days when Reason was serious.

    Oh, you meant those kind of back issues.

  • ||

    I hope they take away his drugs due to the War on Pain Relief.

  • Rich||

    the Obama administration's proposed requirement that doctors not be barred from prescribing narcotic painkillers until they receive and the administration receives "training on the importance of appropriate prescribing and dispensing of opioids to prevent adverse effects, diversion, and addiction."

    FTFY 8-(

  • Almanian||

    Yep, nothing like chronic pain. MUCH rather have that than be "addicted" to some substance - TEH HORRORRSSZ!!!!1!!

    Again - I hope all these drug warriors - every one of them - suffers a collapsed disk in their back and is denied access to any pain relief. We'll set a loaded .45 by them and see how long they can keep from using it.

    Fucking slaver fucks.

  • Almanian||

    Oh, and I ALSO hope they all get kidney stones, which is EVEN WORSE. THAT was the pain I'd truly have killed myself over.

    So - smashed disks AND kidney stones. Now take my barbell set up to the attic - chop chop!!

  • Nomic||

    I had a hangnail the other day...

  • ||

    Cronic Kidney Stones! I pass one around every 9 months! The Joy!

  • Zeb||

    And I bet they don't let you keep some morphine around so you don't have to go to the ER every time.

  • Zeb||

    Kidney stones. I think I have a pretty good tolerance for pain and that is the only think that has ever had me moaning out loud in pain. A little IV hydromorphone quiets that pretty fast.

  • ||

    The drug warriors don't have to worry about it if they do. They get the good stuff that they take from the rest of us.

  • Heroic Mulatto||

    You don't get it Almanian; they would relish the pain.

    How else can they burn away their sins, except in the purifying flame of mortification of the flesh?

  • Heroic Mulatto||

    And for those unwilling/too lazy to follow the link, here's the money quote:

    Some theologians explain that the redemptive value of pain makes pain lovable in its effects, even though by itself it is not. Pain is temporal and limited, thus to undergo it is worthwhile to gain the real benefits. For those with this viewpoint, pain is seen as a means to an end. Thus, a modern Catholic saint, Josemaria Escriva said, while consoling a dying woman who was suffering in a hospital, "Blessed be pain! Glorified be pain! Sanctified be pain!"

    Remember that this is what they actually believe the next time some SoCon/Paleo harps on about the so-called Judeo-Christian roots of American culture.

  • ||

    ...this is what they actually believe...

    Yes, what they believe — because Christians are notoriously monolithic in their beliefs.

  • Heroic Mulatto||

    The pronoun "they" in the first clause of the sentence in the post at @10:04 refers to the "they" in the post at @9:59, i.e. sanctimonius drug warriors.

    But you knew that already, didn't you?

  • Zeb||

    I think that theologians may be right about pain. That is still no justification for a government to deny people relief from pain if that is what they want. No one is making anyone take pain killers who would rather have the spiritual experience of suffering.

  • Tim||

    Good people have to suffer so that non- suffering bad people can be made to suffer by our caring just society.

  • Almanian||

    TIMMEH!

  • Horace||

    Hey, I live near that small Ohio town ravaged by the Oxycontin tornado. In fact, across the alley where I work is a so-called "pain clinic", one of several here. When it's open (about three days a week) the parking lot is overflowing with cars, about half of them from faraway counties and states. Prescriptions are "sold" to "patients" from a doctor. Whether or not these people are in pain or are selling or using them for other purposes I care not. But what really burns me up is when I can't find a parking place when I come back from lunch. So I say ban them all!

    Just kidding. But seriously, because the police can't legally stop these people from obtaining drugs because they're prescribed by a legitimate physician. That's why there's an influx of new laws - like the one recently passed by the local city council and is being challenged today in court:
    http://portsmouth-dailytimes.com/bookmark/12938280

    Being the eye of the hurricane of illegal prescription drugs has not affected me personally (parking problems aside) and I haven't seen how it's "devastated" the community. But I have seen the million dollar mansion that one of the pain clinic physicians just bought last year.

  • Robert||

    Hey, Portsmouth, O. -- Giles HS football, single wing all the way, including buck lateral series!

  • ||

    What type of monster would choose to be a DEA agent or state trooper assigned to a drug task force?

    What type of idiot would argue that liberty is better advanced if we are nice and respectful to such monsters?

  • ||

    A paternal government is a terrible parent. But then I'm a nutty gal who thinks the war on drugs is a waste of time and that the dying shouldn't have to suffer.

    http://www.intellectualtakeout.....e-care-act

  • ||

    Having been a victim of 4 serious spinal surgeries, one seriously botched, I can vouch for the fact that getting relief for serious pain problems is serious pain in the ass. I can not tell you how many times I have wished my pain on judgmental physicians and pharmacists. Just for a month I would like to give the worst of my pain issues to the assholes who make is so tough for pain sufferers to have some normalcy in their lives - the self righteous bureaucrats and drug warriors - so they know what it's like to try to live this way.

  • ||

    doctors vary widely. some will ask you how much and what pain med you NEED and just write the script. others think anything more than vicodin (which is a totally low dose pain killer) is too much

  • Matrix||

    Vicodin can't be! Haven't you seen House? He was addicted to that stuff, and it is apparently a powerful opiod! It's terriblz!!!

  • ||

    it's like frigging pez

    granted, any drug that is extruded from the mouth of mickey mouse is highly dangerous

  • Zeb||

    Eminem too.

    Any opioid can cause nasty withdrawals.

  • ||

    A freaking men!!!!

  • ||

    I don't know how much a role government should play in preventing drug diversion, but the government endorsed pharmacy database in my state has been a boon in helping me cull out the scammers from legitimate patients. To that extent I can prescribe more freely without as much worry that oxycodone is going right to the street or middle school. Yes, people will always abuse drugs. To the extent that medicine enables that by ordering excess quantities or not confronting patients we believe are addicted, medicine contributes to a problem. Not all addicts are happy about their abuse. I favor systems that put barriers in their way. Behavior change is tough. I don't believe that we shouldn't make laws simply because people will break them. If that is what being a libertarian is, include me out.

  • The Fringe Economist||

    Pretty easy for those who aren't in pain to want to "strike a balance" between patients and abusers. Of course when you're not in pain, a balance really just means whatever you're pulling out of your ass - but to someone who's suffering on a daily basis, the only balance you'll ever find in life is to get rid of the pain through drugs.

  • ||

    I wish we'd just make all these opioids over-the-counter. It'd get the actual drug-seekers out of the ER, seeking drugs. The uptick in overdoses would be short-lived.

  • ||

    I'll second that and then some; all drugs should be legal, how is that we required a Constitutional Amendment to outlaw a man made substance but we can outlaw plants willy-nilly?

  • Ricky||

    Thanks ForSharing

  • Regina||

    I am prescribed Vicodin for neuropathic pain that I have due to cervical spinal stenosis and a crushed nerve in my neck. Some days I don't take any. Some days I take up to my recommended dose. It depends on the weather, whether I've been getting any exercise in, etc. I saw a woman on an ABC story about this issue who went from taking three a day to SEVENTY-FIVE a day. They never explained how. But of course, since she was addicted, she thinks they are evil and should be pulled from the market. Because, it couldn't be her, it must be the drug. They didn't try to interview me, or people like me, for whom Vicodin is a tool to be able to keep working and to be involved in their life. Always sensationalist reporting.

  • ||

    The only drug I'm addicted to are french fries: http://lawblog.legalmatch.com/.....g-lawsuit/

  • ||

    ?

  • ||

    Let's make sure I got this right. People in real need of painkillers for their severe ailments will not only not get their medicines but have to endure the next 18 months of POTUS without it as well?

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  • ||

    I am one of these suffering people who cannot get help from any doctor. I have degenerative disc desease which started after an automobile accident eleven years ago. At this point in time, I have a Neuro-surgen who wants to operate, but has told me that I have to get into pain management. I have been to three appointments now at different pain doctors only to be told that "We only give injections." I don't need injections, I need someone to manage my pain before and after surgery. What idiot would get surgery, only to return home on tylenol with staples in their stomach. I don't even know where to get pain relief outside the doctoral world...so how do we fight back? If you have an MRI or medical documentation stating horrible pain..it makes no sense. I do know one thing...my life has no quality anymore because of this new law. My physical pain has only brought the depression and emotional pain that I would wish on nobody. How do you get help?

  • nike shox||

    is good

  • neil||

    Working at a well known non 12 step drug rehab I know one of the major issues is physicians and dentists prescribing prescription painkillers way too liberally.

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