The Government's Medical Meddling Hurts Pain Patients

The Associated Press reports that "sales of the nation's two most popular prescription painkillers [hydrocodone and oxycodone] have exploded" during the last decade, "worrying experts who say the push to relieve patients' suffering is spawning an addiction epidemic." A.P. acknowledges that "the increase is partly due to the aging U.S. population with pain issues and a greater willingness by doctors to treat pain"—a positive development, given how scandalously inadequate the medical response to pain was when the upward trend in painkiller prescriptions began. But the general thrust of the piece is that doctors, once execessively stingy with opioids, are now excessively generous, and therefore something needs to be done. The problem is that all the likely government responses will tend to make it harder for patients with severe chronic pain to get the relief they need.

Washington state, for example, has responded to the perception that doctors are overprescribing opioids by establishing an arbitrary threshold beyond which pain patients can no longer receive treatment from their primary physicians. Doctors with patients who are taking "any opioid equivalent in strength to a daily dose of 120 milligrams of morphine," The New York Times reports, must refer them "for evaluation by a pain specialist if their underlying condition is not improving." The results have been predictable:

Even before the new provisions took effect, some doctors stopped treating pain patients, and more have followed suit. Christine Link, 50, said that several doctors had refused to refill the prescription for painkillers she had taken for years for a degenerative joint disease.

"I am suffering, and I know I am not the only one," she said....

The state law has transformed the clinic at the University of Washington into a pain treatment center of last resort—and Dr. [Jane] Ballantyne, the pain expert, into an appeals judge of sorts because she sees patients referred for evaluation under the law. On a recent day, she was seeing a stream of castoff patients, including Ms. Link, who sat hunched in a wheelchair, suffering from a degenerative joint disease.

"They all said that I can't treat you, you need to see a specialist,” Ms. Link said of her other doctors.

The Times illustrates the impulse behind Washington's law with an anecdote about a patient who "was taking dosages so high that another doctor who examined her was shocked. 'She said, "I don't want you to die,"' [the patient] recalled." Yet tolerance to opiods' respiration-suppressing effects develops along with tolerance to their analgesic effects, so chronic pain patients who use such drugs every day for years can safely take doses that would kill a novice. It is impossible to say in advance what dose is appropriate for any given patient, let alone for patients generally.

Rep. Mary Bono Mack (R-Calif.) is pushing similar medical meddling at the federal level. Her Stop Oxy Abuse Act would decree that oxycodone should be used only for "severe" pain, as opposed to "moderate-to-severe" pain, as the Food and Drug Administration's current guidelines say. Like Washington's dose limit, this restriction arbitrarily overrides the medical judgment of individual doctors, who may find that oxycodone is superior to the alternatives for particular patients with moderate pain. Bono Mack's Ryan Creedon Act would require that doctors "obtain training or certification on addiction to and abuse of controlled substances and appropriate and safe use of controlled substances" before they can legally prescribe not only opioids but any scheduled drug, with the standards for the training to be set "by the Secretary of Health and Human Services in consultation with the Attorney General." This requirement would encourage doctors to be suspicious of patients seeking pain treatment or to simply stop prescribing opioids altogether (especially if the bill is narrowed so that it applies only to opioids or only to Schedule II drugs, as seems likely). While reducing access to these drugs may inconvenience a few addicts, pushing them into (or back into) the black market, it will also force patients like Christine Link to suffer needlessly. 

The Ryan Creedon Act is named after a 21-year-old from Bono Mack's district who died in 2009 from an overdose of OxyContin he obtained by scamming doctors. Attempts to separate people like Ryan Creedon from the drugs they want inevitably hurt legitimate patients because pain cannot be objectively verified. Doctors can do physical examinations and consider a patient's medical history, but at a certain point they have to decide whether to trust him. A mission to help patients like Christine Link points in one direction, while a mission to save addicts such as Ryan Creedon from their own recklessness points in another.

[Thanks to Virginia Postrel for the Desert Sun link.]

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  • Mr. FIFY||

    This is happening on Obama's watch.

  • ||

    Is there a problem with people being "addicted" to painkillers in their twilight years? What, precisely, might it be? If quality of life means anything, I can't figure it out.

  • Hugh Akston||

    Roving gangs of enfeebled and disabled old people cruising the streets in their Rascal™ scooters. Stealing, whoring, and killing just to score the next fix of that sweet, sweet codone. 800% rise in cane-related assaults. Legions of old people sucking dicks in retirement village back alleys for Oxycotin money, then dying of exposure because they are unable to get up off their knees.

    These are the risks you take by even asking that questions.

  • A Serious Man||

  • ||

    You're more right than you know, Hugh.

  • Heroic Mulatto||

  • TELLMOFF||

    Do a google search: Rep. Mary Bono picture lickin breast (radaronline). This is what happens when you abuse drugs.

  • TELLMOFF||

    There is nothing wrong with twilight-years-addicts. There is something wrong with people who believe that drug persecution is caused by the lack of libertatian enlightenment. All persecutions are caused by mean villians who know that people don't care enogh about their fellow man to fight persecutors like Rep. Mary Bono.

    Let's come up with a plan to expose this law maker to the hatred that she deserves.

  • ||

    Politicians are such scum. Someone, somewhere might be getting too many pain killers, so the solution is OBVIOUSLY to make all chronic pain patients suffer.

  • TELLMOFF||

    What shows politicians to be even worse scum is the phony idea that they are making patients suffer because of concern about the death of a dope fiend by the name of Ryan Creedon.

  • Lord Humungus||

    there are worse things than addiction - like extreme pain. recently I had an infected tooth that hurt worse than breaking two ribs. If you want to see a man drive like a maniac, you should have watched me trying to get home to my Vicodin the day I forgot it after the second part of the root canal.

  • plu1959||

    They're just doing this to stick it to Rush.

  • ||

    But the general thrust of the piece is that doctors, once execessively stingy with opioids, are now excessively generous, and therefore something needs to be done.

    Why is nearly every reporter on the planet a fucking scumbag concern troll?

  • Citizen Nothing||

    It's a living.

  • ||

    There has to be more to it than that. Because they're all concern trolls the same way.

  • tarran||

    They're everywhere.

    I took the kids to the Boston Museum of Science on Sunday, and they had exhibits strategically located across the Museum designed to objectively prove using science that society needs to tax sugar.

    I was tempted to lean over to the Juggalo and Juggalette* that were wandering around and say, "see that guy over there, he wants to tax the shit out of Faygo to make it more expensive"

    But then I remembered the human misery caused when the Germans unleashed the Bolsheviks on the Russians and had a vision of that guy in Africa whose pet Hippo bit to death and decided to walk away.

    *The word vacuous does not do justice to the emptiness in their eyes.

  • ||

    I do love that museum, though. I've been there probably 50 times. And back when the Computer Museum was its own structure instead of two rooms at the Science Museum, and throw in the Children's Museum...that was some fun shit.

  • tarran||

    It's gone downhill:
    1) The giant tubes showing the difference between things falling in a vacuum and surrounded by air is gone.

    2) Most of the space-craft models are gone. They had a Naboo starfighter hanging where the Apollo-Soyuz model had hung for a time. That disappeared a few months ago with nothing replacing it.

    3) The interactive stuff is dumbed down heavily.

    4) The level of concern trolling (generally centered around the lecture hall) has gone up. The activists have the slickest displays.

    5) 50% of what's shown in the movie theaters are basically propaganda pieces put out by Green-peace and the WWF.

    5) The computer museum (where I volunteered in high school, BTW) is a mixture of great exhibits and things that are so childish, it insults the intelligence of two year olds.

    6) The best exhibits are generally in a state of disrepair, as if they don't have the money to maintain them.

    7) The dioramas are slowly disappearing as their disrepair becomes so embarassing that even the museum decides to hide them.

    8) And yet, they have some incredible exhibits that were cheap to manufacture but are ingenious in their design that pop-up from time to time, meaning that there is still hope that it can be saved.

    IF I ever make a huge pile of money, I'd love to buy the Museum outright, and completely rework it in a Day the Universe Changed way.

  • ||

    Really? Fuck. Last time I was there was 2007. The starfighter was there then.

    What a shame. Museum Wharf had some glory days once.

    Now I guess you just go to Faneuil Hall and Quincy Market and get some powdered dough.

  • tarran||

    It's worth a visit. Next time you're in town I can take you.

    I have a membership that allows me to bring guests. A 4 hour visit can be had for 10 bucks, and it's hard to stay dour when the kids are having fun.

  • fried wylie||

    exhibits strategically located across throughout

  • ||

    If they didn't concern troll, the amount of material they would have to write about would decrease by a factor of ten, at least.

  • Loki||

    ^This. Unlike the "old days" when news was on for maybe 2-3 hours a day, now we've got who knows how many 24 hour news channels, and they have to make sure they have enough material to fill up a "24 hour news cycle". Unfortunately that means concern trolling or blowing shit hugely out of proportion. And they wonder why they're losing market share.

  • ||

    Shit. Sensationalist garbage like this was around before the 24hr news cycle.

  • Hugh Akston||

    Addiction is teh evel, Epi. It's in the Constitution.

  • Citizen Nothing||

    Many become journalists because they want to right wrongs and because they are too dumb to do anything else -- a dangerous combination.

  • R C Dean||

    "Journalists" are concern trolls by definition. These are not mere "reporters"; they are journalists, with a divine mission not to merely gather and report crude facts.

    If their portfolio extends beyond mere facts, then it must include some Larger Purpose - "speaking truth to power", "comforting the afflicted and afflicting the comfortable", whatever.

    So, every article must tie back to the Larger Purpose, but must do so in a way that preserves a fig leaf of Not Pushing An Agenda, No Siree. Just asking questions, that's all.

    Hence, concern troll.

  • Eduard van Haalen||

    I looked up "concern troll" on the Urban Dictionary, but I couldn't find a definition which exactly matched these reporters.

    Am I a concern troll for saying this?

  • Eduard van Haalen||

    Wait, I think I see.

    But I'm concerned that you're discrediting yourselves by...just kidding.

  • kinnath||

    We can only hope that these fine legislators find themselves living in extreme pain during their twilight years, unable to get the medications that they need to live a decent life.

  • ||

    They're in the club, dude. They have gold-plated lifetime health plans paid for by you and me, the rules only apply to the little people, and oh yeah, fuck you that's why.

  • Heroic Mulatto||

    Rep. Mary Bono Mack (R-Calif.) is pushing similar medical meddling at the federal level. Her Stop Oxy Abuse Act would decree that oxycodone should be used only for "severe" pain, as opposed to "moderate-to-severe" pain, as the Food and Drug Administration's current guidelines say.

    I assume Rep. Mack is highly knowledgable in the neurophysiological and neuropsychiatric mechanics of pain so that she can accurately define what "severe" means in this piece of legislation that will effect millions.

  • Loki||

    That's what the TOP MEN at HHS are for. More executive branch power FTW.

  • ||

    I think I must have the abridged version of the U.S. constitution. I don't see where my copy allows congress to regulate doctor/patient transactions.

  • fried wylie||

    The abridged version should have it too:

    "Necessary...Commerce...Fuck You, That's Why."

  • TELLMOFF||

    Rep. Mary Bono doesn't know anything about the mechanics of pain. She does know that persecuting drug addicts will get her votes from our domesticated voters who don't want their kids to become addicts. Don't say that these voters are dumb. They are weak minded and easily scared.

  • fried wylie||

    Don't say that these voters are dumb. They are weak minded and easily scared.

    OK, Captain Specific.

  • Alan||

    Rep. Bono Mack thinks "a limited time" means "forever less a day" - so yeah, she's a real genius.

  • Wilt Chamberlain||

    Is it bad that I often daydream about these politicians ending up with horrible back pain once they retire? And I hope they are denied essential painkillers, and are forced to live out the rest of their lives with the consequences of their legislation?

  • A Serious Man||

    Congresscritters being held to the same rules as us peons? What kind of nonsense is that?

  • fried wylie||

    not backpain. inoperable foot pain.

  • Alan||

    Her late husband died when he skied into a tree. We can only hope Rep. Bono Mack doesn't go so easily.

  • Heroic Mulatto||

  • A Serious Man||

    I'm sure the black marketeers are thrilled at this.

  • Fatty Bolger||

    What they need to do is pass the "Nobody Else Should Have To Suffer Just Because Ryan Creedon Was A Douche Act".

  • Concerned Citizen||

    They're feverishly trying to make Ohio safe from those evil pain killers. Of course, should a legislator ever need medical ganja or pain killers, supply won't be a problem.

  • kinnath||

    I am ready to take on the mantle of Social Darwinist and let dickheads like Ryan Creedon die in the streets. And then I'll explain to my grandchildren: "See this is what happens when you're a dickhead like Ryan Creedon".

  • TELLMOFF||

    Ryan wasn't a dickhead. He lacked selfcontrol.

  • kinnath||

    The Ryan Creedon Act is named after a 21-year-old from Bono Mack's district who died in 2009 from an overdose of OxyContin he obtained by scamming doctors.

    I guess it just depends on your definition of dickhead.

  • The Unknown Pundit||

    I read stuff like this and I feel like I'm taking crazy pills.

    Well, not really, as crazy pills have been banned by our friends in government.

  • fried wylie||

    as crazy pills have been banned by our friends in government

    Pills that ONLY make you crazy are banned, but there's still plenty of legal options for pills that could make you crazy as a side-effect.

  • BakedPenguin||

    So long as you don't enjoy the effect, they're okay. It's that damned pleasure that's the problem.

  • Enjoy Every Sandwich||

    My mother suffered terrible pain in the final years of her life because her doctors were too afraid of the government to give her enough pain medication to last through a given month.

    "Addiction"? Fuck. Her dependence on painkillers was a result of the pain. Pain that the doctors admitted they would never be able to fix.

  • fried wylie||

    Her dependence on painkillers was a result of the pain. Pain that the doctors admitted they would never be able to fix.

    This, A Thousand Million Billion Times This.

  • Andrew S.||

    I see my mother suffer from pain every day due to MS and fibromyalgia. Because of laws like this, and Florida's "pill mill crackdown", she can't find a doctor who's willing to prescribe adequate pain relief.

    I consider myself to be a very nice person. I have trouble wishing ill against anyone. But I really can't help but hope that any politician who comes up with legislation falls victim to a terribly painful degenerative disease, and is unable to find a doctor to adequately treat their pain.

  • Concerned Citizen||

    I hope your mother finds relief. If this were the 1840s, she could get whatever she wanted from the local pharmacy, without a prescription. Franklin was right, we've traded our freedom for security and have neither.

  • fried wylie||

    "The dream of the 1890's is alive in..."

  • Alan||

    On another board I mentioned that there was a problem in Florida because doctors were afraid to prescribe pain medication. A Floridian told me that I was wrong, and that in fact doctors in Florida prescribe so much more pain medication than they need to that the government is cracking down on them and sending many to jail.

    I just love Floriduh!

  • The Unknown Pundit||

    Do any of these legislators or other instigators of these harmful laws ever address these access issues?

    There's only one thing worse than a crooked politician and that's one who is trying to do "good".

  • ||

    They're not trying to do any good. They're trying to get votes.

    Politicians do things for one reason: the continuation and expansion of their own power.

  • kinnath||

    The Ryan Creedon Act

    It's all about pictures of dead boys and girls that can be associated with catchy names for polictial actions.

    Bonus points if you can place another aspect of human life under the control of a non-elected, public-union, employee-for-life.

  • DWC||

    Yeah, I would take a hundred Huey Longs over one of these Bono bitches.

  • DWC||

    Fucking drug hysteria. The drug war is evil in its conception and its consequences and is perpetuated by evil, self serving people. After 3 neck surgeries and 1 lumbar surgery I used hydrocodone for years and oxicontin for years. Both of which I just got sick of - largely because their benefits hardly outweighed their costs in my particular case - and just quit. It wasn't exactly a joy stopping either cold turkey, but I've certainly been through worse. This panic over what drugs other people are taking is based in worst sort of puritanical, busybody mentality. I can't say how many people take their own lives each year for want of effective pain treatment. It wouldn't surprise me if it were in the thousands. I lay those deaths at the feet the fucking asshole drug warriors and their agenda.

  • Heroic Mulatto||

    The drug warriors would feel justified in raiding and possibly killing George Washington and Thomas Jefferson, for their hemp farms.

    Because, you know, America.

  • fried wylie||

    movie pitch:

    The DEA confiscates a working time machine from an LSD bust and uses it to go back in time to kill George Washington.

  • fried wylie||

    Starring Rob Schnieder.

  • DWC||

    I have to say the blonde girl in the Bad Idea Tee Shirt ad looks almost exactly like a girl I was desperately in love with and who did her level best to turn my heart into mince meat. I can't visit this site without feeling a little sick because of it.

  • شات عراقنا||

    thanks

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