An 'Alarming' Improvement in Pain Treatment

Jacob Sullum | August 20, 2007

Speaking of pain treatment, A.P. has a confusing jumble of a story on the subject with an ambivalent tone summed up in the lead: "People in the United States are living in a world of pain and they are popping pills at an alarming rate to cope with it." If people are "living in a world of pain," why is their consumption of painkillers "alarming"?

The hook for the story is an A.P. analysis of DEA numbers that found "the amount of five major painkillers sold at retail establishments rose 90 percent between 1997 and 2005." A.P. worries that "more people are abusing prescription painkillers because the medications are more available," and it implies that pharmaceutical companies, through slick marketing campaigns, are raising consumption of their products above a level that is medically appropriate.

But as the story notes, there are perfectly legitimate explanations for the increase in painkiller consumption, including the aging of the population and a more enlightened approach to pain in which doctors seek to control it as much as possible instead of telling patients in agony to tough it out. Furthermore, A.P. (to its credit) reports, many physicians, "spooked by high-profile arrests and prosecutions by state and federal authorities," have stopped prescribing narcotics, and "people who desperately need strong painkillers are forced to drive a long way" to get them.

So are doctors too loose with painkillers, or too stingy? Are Americans consuming too many, or not enough? It's possible, of course, that the pills are going to the wrong people, to malingerers, addicts, and drug dealers instead of legitimate patients. If so, the problem is not the quantity consumed but the way in which it's distributed. But that problem is not as easy to fix as the DEA would have you believe. Since pain cannot be objectively verified, the crucial variables are doctors' inclination to trust patients and willingness to help them by prescribing narcotics. In practice, as pain treatment improves, as more people in severe pain get the relief they need, more fakers will slip through. Conversely, as doctors become more suspicious of patients and/or more fearful of losing their licenses, livelihoods, and liberty, fewer people will obtain drugs for nonmedical purposes, but more patients will be denied the medication they need to make their lives livable. This ineluctable tradeoff between drug control and pain control is the reason A.P. can't seem to make up its mind about whether an increase in the sale of painkillers is good news or bad news.

[Thanks to ~~SPB~~ SPD for the link.]

Help Reason celebrate its next 40 years. Donate Now!

Try Reason's award-winning print edition today! Your first issue is FREE if you are not completely satisfied.

Bee|8.20.07 @ 12:04PM|#

I read that article this morning, and thought to myself, "So, what exactly is the point here?" Is this what passes for a professional editorial? It's like they just can't stop themselves from clucking at someone, even if that someone is a vanishingly small number of people who resort to theft or violence to keep themselves in soma.

SPD|8.20.07 @ 12:26PM|#

[Thanks to SPB for the link.]

Eh, close enough.

|8.20.07 @ 12:32PM|#

[Thanks to SPB for the link.]

Eh, close enough.

Agreed.

|8.20.07 @ 12:35PM|#

as doctors become more suspicious of patients and/or more fearful of losing their licenses, livelihoods, and liberty, fewer people will obtain drugs for nonmedical purposes, but more patients will be denied the medication they need to make their lives livable.

Fewer drugs! Case closed! Fewer drugs, that's all you need to know. We've got to send the right message to the children. And nothing says "just say no" like watching Grandma suffer.

|8.20.07 @ 12:36PM|#

I don't think it's unfair to say that any situation where an increasingly large number of people are sedating and anesthetizing themselves to make their lives "livable" is kind of alarming.

Frankly, I'm surprised that libertarians aren't at least a little more lukewarm about the role of pharmacology in our culture.

Many dystopian works of fiction warn us that drugs may be used to control people and therefore we might want to be a little skeptical of the whole "if it hurts, take a pill for it" attitude.

|8.20.07 @ 12:40PM|#

It's possible, of course, that the pills are going to the wrong people, to malingerers, addicts, and drug dealers instead of legitimate patients

Umm.. just looking for a little consistency here. Why are these the wrong people to receive these drugs? Or do you mean "wrong" people as in "not the intended party?" Although even then... what's the big deal about it going to an addict if the addict isn't hurting anyone? ;) ;)

|8.20.07 @ 12:46PM|#

Frankly, I'm surprised that libertarians aren't at least a little more lukewarm about the role of pharmacology in our culture.

I don't think that's a fair assessment. Libertarians are consistent in arguing for the legality of drug use. Arguments for it's morality can be all over the map. And this is true for most topics. There's always a difference between arguing for the freedom to act vs. the desirability of that action.

|8.20.07 @ 12:47PM|#

Dan T. - i hope you find out what it's like to live in pain 24/7 and not be able to get pain treatment, you asswipe...

|8.20.07 @ 12:52PM|#

Reinmoose,

There is a (compelling) libertarian argument for ending prohibition on all drugs. That is not the one being discussed here however. In this case, Jacob is making the point that, even if one concedes that only medically necessary (assuming that at least SOME pain treatment is "medically necessary") medication is allowed, trying to sort out the difference inevitably results in unnecessary suffering. And that suffering compared should outweigh the harm of some drugs finding their way into the "wrong" hands.

SPD|8.20.07 @ 12:57PM|#

Well put, MP. Just because libertarians advocate legalizing certain acts doesn't mean once that would happen we'd all run out and engage in pill popping, pot smoking, brothel visits, gay weddings and weekend trips to Cuba. (Of course, I can speak only for myself, because that does sound like one hell of a good time.)

|8.20.07 @ 1:01PM|#

I don't think that's a fair assessment. Libertarians are consistent in arguing for the legality of drug use. Arguments for it's morality can be all over the map. And this is true for most topics. There's always a difference between arguing for the freedom to act vs. the desirability of that action.

I understand that, and in this case I'm not talking about the morality of taking drugs.

I'm saying that libertarians are often very strongly in favor of granting people the freedom to take drugs but at the same time tend to ignore that drugs can be used as a means of controlling people.

SPD|8.20.07 @ 1:07PM|#

I'm saying that libertarians are often very strongly in favor of granting people the freedom to take drugs but at the same time tend to ignore that drugs can be used as a means of controlling people.

Having just watched Equilibrium I won't deny that. But the same argument can be made for television, literature and gun control. Stating that something might be used for less than noble purposes isn't a strong enough argument to advocate outright restriction (i.e., government-imposed restriction) on whatever that thing might be. People should have the right (and responsibility) to decide for themselves.

SPD|8.20.07 @ 1:09PM|#

Scratch "gun control" in my last post. That should have read "guns." A Bradyan slip on my part, I'm afraid.

Anonymo the Anonymous|8.20.07 @ 1:22PM|#

I'm saying that libertarians are often very strongly in favor of granting people the freedom to take drugs but at the same time tend to ignore that drugs can be used as a means of controlling people.

He's quite the controversial figure even among libertarians, but some agree to some extent with the beliefs of Thomas Szasz, whose work speaks to your concerns. And it's certainly not uncommon to hear some libertarians offer the usual complaints about Ritalin, etc., though others, of course, disagree.

As for why it's "alarming"... Probably because these people's ability to find an objectively beneficial use for painkillers without becoming crack whores and murderers greatly undermines the case for the War on Some Drugs, which is the foundation of all modern law enforcement in America. If I staked my credibility on the WoSD, I'd be alarmed too.

rosko|8.20.07 @ 1:28PM|#

I'm saying that libertarians are often very strongly in favor of granting people the freedom to take drugs but at the same time tend to ignore that drugs can be used as a means of controlling people.

I don't ignore it. In fact, aside from the basic issue of personal freedom, I see this as one of the critical reasons to keep the government away from the manufacture and distribution of drugs (particularly psychoactive ones). Drugs can only effectively be used to control large numbers of people if these people are forced to keep taking the drugs. Otherwise, if people are taking drugs voluntarily, someone is bound to realize if they are a hidden tool of social control and warn others to stay away. To a limited extent, the situation of compulsory drug-taking is already occurring for certain people with particular psychiatric disorders, though from what I've heard all the dystopian fiction involving drugs has this phenomenon extended to cover the vast majority of the population.

A problem of somewhat lesser severity can arise when certain drugs are prohibited and others are allowed. If the only pain medication, antidepressant, etc. available is one that produces a mental state conducive to control, people have no choice but to suffer or submit (but at least they have a choice). Contrarily, if people can take any medication they wish, there is no way for a would-be social controller to subtly bias people's mental worlds. In this way, the issue of drug prohibition takes on a greater significance than simply how someone chooses to have fun.

|8.20.07 @ 1:36PM|#

I understand that, and in this case I'm not talking about the morality of taking drugs.

I'm saying that libertarians are often very strongly in favor of granting people the freedom to take drugs but at the same time tend to ignore that drugs can be used as a means of controlling people.

What a complete load of shit. If you had any idea of what people with 24/7 pain go through you would know that the without drugs the pain controls them. The drugs are the only way they can even get through the day sometimes.

People aren't all built the same. Some rolled snake eyes in life and either through genetics or accident they have a much lower tolerance for pain than rest of the population.

BruceM|8.20.07 @ 1:40PM|#

The first rule of journalism requires that any story about drugs or even tangentially related to drugs has to be alarmist. In fact, I think it's also a federal regulation somewhere (remember, the first amendment doesn't apply to drugs so such a regulation is permissible).

undergroundman|8.20.07 @ 1:52PM|#

The problem is that painkillers are a band-aid for a deeper problem which isn't being recognized. To some degree that problem is simply that there are too many old people in the world, and these people are living longer and, in many cases, more dependently -- meanwhile 90% of the world's population lives in abject poverty. (Yes, I will be shooting myself the moment I'm forced to wear diapers.) The only solution to this is an increased acceptance of euthanasia and personal responsibility. I certainly don't want my families last memories of me to be suppressed resentment over economic burden and neglection guilt.

Also, it's pretty obvious at this point that people are susceptible to advertising, and will pop pills even when it's not good for them (Acetaminophen causes liver damage and kills many people very year).

One thing that libertarians prefer not to recognize is the fact that the pharmaceutical companies focus on cash drugs rather than lifesaving drugs: anti-depressants, sexual enhancers, ect. Stiglitz proposed government-funded prizes to increase research on lifesaving drugs, which I feel is the best plan.

undergroundman|8.20.07 @ 1:56PM|#

Anonymo the Anonymous|8.20.07 @ 2:12PM|#

I could pop pain pills and get surgery someday or I could start shaping up.

Because you couldn't possibly do both.

|8.20.07 @ 2:28PM|#

One thing that libertarians prefer not to recognize is the fact that the pharmaceutical companies focus on cash drugs rather than lifesaving drugs: anti-depressants, sexual enhancers, ect. Stiglitz proposed government-funded prizes to increase research on lifesaving drugs, which I feel is the best plan.

Now why could that be? Maybe it's because lots of people are willing to pay for them to make their lives better? So is it just possible those companies are responding to the needs of the people?

I have back pain, but at least I recognize that it's from a deeper problem: sitting too much, sleeping on my side, and not exercising. I could pop pain pills and get surgery someday or I could start shaping up.

Ah yes it's all just a matter of sitting properly and your pain will all go away. Why didn't I think of that. Look you jackass some people aren't built so that a few protein shakes and some yoga will make all their problems go away. Quit acting as if everyone has the same physical make up. Some people need pain medication and it shouldn't be up to you or anyone else to tell them how much pain they are actually in.

highnumber|8.20.07 @ 2:31PM|#

Libertarians are usually not all that economically savvy...

IANAE, but I can tell you aren't too savvy economics-wise yourself, partner.
How's that glass house holding up?

|8.20.07 @ 2:37PM|#

It's possible, of course, that the pills are going to the wrong people, to malingerers, addicts, and drug dealers instead of legitimate patients.

Ummm, Jacob, did anyone tell you that this is allegedly a libertarian website? That, while you might not personally approve of someone else's drug use (and, as a Mormon, I encourage everyone to quit harming themselves by using such drugs for recreational purposes), that it's a terrible idea to let the government make that decision for you? And, that on such a website, it's a bit clueless to characterize as the "wrong people" those entrepreneurs who try to subvert this unconscionable usurpation of personal liberty and free agency?

|8.20.07 @ 2:40PM|#

undergroundman -- Just do situps. Work up to about 50 a day.

My wife's an orthopedic surgeon, and she tells her patients with back pain that it's usually caused by weak stomach and back muscles. The ones that do the situps usually find a remarkable improvement, and often even become pain-free.

|8.20.07 @ 2:42PM|#

Many dystopian works of fiction warn us that drugs may be used to control people and therefore we might want to be a little skeptical of the whole "if it hurts, take a pill for it" attitude.

Many dystopian works of fiction also warn us of the dangers of alien invasions, nanite swarms and evil wizards. The key word here is "fiction."

VM|8.20.07 @ 2:53PM|#

IAAAE, and I think you're dreamy

Steve Verdon|8.20.07 @ 3:00PM|#

Libertarians are usually not all that economically savvy (what's their stance on the recent subprime mess? externalities, imperfect information, and irrationality will lead to heavy losses for even the prudent, and could lead to crisis for all of us -- yet libertarians and Chicago School economists snort at "predatory lending")

Actually, even if we based government intervention on just your list above, we'd have a far, far smaller government IMO. For example, with imprefect information we could have the government act as a clearing-house for information. Want to know about a drug? Go to the FDA's website and look it up. There are damn few federal externalities, so the EPA would have to change its scope dramatically. Possibly as, once again, a clearing-house for information and also possibly as an arbiter between local/state jurisdictions. There are only a few real federal/national public goods, so we could get rid of the Department of Education, the Department of Labor (although keeping the BLS is probably recommended on the grounds of helping with informational asymmetries), etc.

Somehow though, I don't get the feeling this is exactly what you meant though. Your grasp of economics is probably pretty bad too, IMO. For example, you write,

Markets need to be regulated because people are stupid and greedy.

This doesn't necessitate regulating markets, but a paternalistic system where some super-human agency controls people's lives. After all, how can a State run by people, who are stupid and greedy, run things any better? If people are stupid and greedy in markets do they become altruistic and intelligent when dealing with/running elections, bureaucracies, and government agencies? Lets put it this way, you think people are stupid and greedy because they do things you don't agree with. A rather arrogant position when you get right down to it.

|8.20.07 @ 3:01PM|#

Many dystopian works of fiction also warn us of the dangers of alien invasions, nanite swarms and evil wizards. The key word here is "fiction."

But one of the roles of speculative fiction at least is to give people a way to think about future events and problems. Look at how many people envoke the entirely fictional book 1984 by George Orwell when warning us about giving up liberty to the government.

lunchstealer|8.20.07 @ 3:44PM|#

Fiction has shown us the dangers of what might happens if our clones on the clone farm find out that 'winning the lottery' and 'going to the island' are euphamisms for having their organs harvested. Doesn't mean that we should stop harvesting their organs, does it?

highnumber|8.20.07 @ 3:46PM|#

IAAAE = I Am An A**hole Economist?

Joke. It's a joke!

VM|8.20.07 @ 3:59PM|#

works for me!

:)

Robert|8.20.07 @ 4:20PM|#

A.P. has a confusing jumble of a story on the subject with an ambivalent tone summed up in the lead: "People in the United States are living in a world of pain and they
are popping pills at an alarming rate to cope with it." If people are "living in a world of pain," why is their consumption of painkillers "alarming"?

Couldn't it just mean that they're alarmed that so many people are so sick as to need so much drug? I couldn't say one way or the other from the article, but that seems a reasonable reading.

lunchstealer|8.20.07 @ 4:42PM|#

If so, they might want to re-position their modifiers. Something along the lines of "Alarming numbers of people are living in such a world of pain that they have to pop pills to cope with it."

But they way it's written, it's the rate of pill popping that's alarming, not the rate of pain suffering.

Either bad writing or bad thinking.

undergroundman|8.20.07 @ 5:30PM|#

This doesn't necessitate regulating markets, but a paternalistic system where some super-human agency controls people's lives.

The Savings and Loans Crisis was caused by a lack of regulation, and this current subprime mortgage lending crisis has also been caused by a lack of regulation. The people who sold these mortgages with no documentation of income were obviously quite short-sighted. Who knows what Moody's was thinking in rating many of these as AAA. Who knows what the hedge funds were thinking. Regardless, financial institutions and markets often benefit greatly from regulation (e.g., SEC filings).

And my grasp of economics is bad because I think markets need to be regulated? By extension, all the Federal Reserve economists must have a "pretty bad grasp of economics". No, I'm sorry -- what makes libertarians such bad economists is that they don't understand that their is a world of economics beyond strict laissez-faire capitalism.

For example, I have gluten intolerance. Up until a few years ago I would have had nearly no way to tell if a product had wheat in it. Now, thanks to a simple, costless regulation, I know if there's wheat in a product -- although I don't know if there's barley-derived ingredients, so it doesn't go far enough.

Similarly, one simple regulation for the mortgage business would be a simple table showing the major risks of an ARM.

By the way, mortgage lenders have already tightened up their standards -- but Bernanke's bailout (a form of regulation) isn't going to help things in the long-term.

SIV|8.20.07 @ 6:16PM|#

It was Predatory Borrowing!

Moody's didn't rate the shit mortgages AAA.
They rated the shit paper made out of mortgages.

|8.20.07 @ 6:19PM|#

I think we should certainly err on the side of giving out more pain medication, not less, and the prosecution of doctors on this issue is a travesty. If some stoner gets a few vicodine, so what? It's his body (props to jh on this), let him do whatever. But the real tragedy is the person in pain who can get no relief because the government doesn't "trust" her (isn't it supposed to be the other way around, with the citizenry having a healthy distrust of government?).
I'm not worried at all about drugs being used as a literal opiate of the masses to allow evil governments and corporations to screw us. In fact, government and corporations always beat the drums AGAINST drugs because they want us productive and confromist, and mind-altering threatens that. Screw them!

|8.20.07 @ 7:11PM|#

The Savings and Loans Crisis was caused by a lack of regulation...

The S&L crisis was caused by dumbass Federal guarantees on investor deposits. The S&Ls could invest in anything, no matter how risky, because they knew the government would bail them out if the investments went belly up.

...libertarians ...tend to ignore that drugs can be used as a means of controlling people.

You mean like Forced Ritalin use in government schools?

LarryA|8.20.07 @ 10:00PM|#

Libertarians are usually not all that economically savvy

I.e. we tend to disregard approved economic theories with stupid questions like, "But where in the real world can you observe that principle actually working?"

Theodore Dawes|8.21.07 @ 7:29AM|#

Since pain cannot be objectively verified, the crucial variables are doctors' inclination to trust patients

A lot of society's problems could be solved if someone invented a foolproof truth detector.

VM|8.21.07 @ 11:35AM|#

Larry-

Huh? If the dichotomy is between the "not that economically savvy" and what you wrote, I'd go with the former. and expand it to "most aren't economically savvy".

Look back at the minimum wage argument. We had self described libertarians arguing from the most basic of Econ 120, while actual studies were ignored or not understood. Exactly the opposite of what you're claiming. We have people claiming "Laffer curve" when that doesn't describe the mechanism they think they're addressing. Stuff like that.

Basics of economic analysis most exactly do (attempt to) address the real world:
scarcity of resources (opportunity costs)
assumption of rational decision making
marginal analysis
econometric modeling.

the models are tested empirically, and there is a danger of pushing the models too far. Models can also be abstract - simplifications to make sense of the larger workings. Think of a drawing of the solar system - that's abstract, not-to-scale, but it gets the basic point across. As with all simplistic models, it's limiting. Or think intro to physics. PV=NRT. That doesn't "work" in the "real world", but serve as a framework. And it has basic usefulness.

Steve Verdon|8.21.07 @ 2:09PM|#

Actually undergroundman there were a number of contributing factors. One commenter highlighted the problems of insuring deposits from a moral hazard/adverse selection point of veiw. Definitely a government policy/regulatory failure. Another was the governments/Federal Reserves inability to appreciate the asset-liability mismatch risk. Another policy/regulatory failure as well.

As for the Federal Reserve they also played a role, or more accurately regulations/policy played a role in the Great Depression. Since the U.S. had gone back to the Gold Standrad, it limited the amount by which the Fed could increase credit/liquidity. This in turn meant the Fed/Government had its hands tied when it came the banking panics/bank runs. The money supply contracted by 1/3rd thus taking what might have been a recession and turning it into a depression.

Now you might say, "See, you admit government can regulate the economy/markets." Yes, in theory this is possible. In theory, lots of things are possible in economics, but in "the real world", to quote you, they are not. The informational constraints that impact individuals also impact the government as well. Hence my view that if you are going to have the government do anything, have it provide information to the public. I like what the Bureau of Labor Statistics does. They provide lots of important economic information and do so in a very low cost manner.

Reason Magazine

Get Reason E-mail Updates!

Site comments/questions:

Media Inquiries and Reprint Permissions:

Editorial & Production Offices:

advertisements