Is It Chilly, or Is It Me?

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In a press release issued yesterday, the Drug Enforcement Administration claims it's a "myth" that efforts to prevent diversion of controlled substances have a chilling effect on doctors' prescription practices. "Doctors Operating Within the Bounds of Accepted Medical Practice Have Nothing to Fear From DEA," says the headline. The problem is that doctors have to predict what the DEA will consider to be "accepted medical practice." Does it include, for example, long-term treatment of chronic pain with large doses of opioids?

To demonstrate the absence of a chilling effect from regulatory penalties and prosecutions, the DEA notes that in the first three quarters of fiscal year 2003 it investigated only 0.06 percent of the nearly 1 million doctors who are registered to prescribe controlled substances. That figure does not include investigations by state regulators where no DEA action is taken.

The DEA does not seem to understand what chilling effect means. It's an effect that goes far beyond those directly targeted by the government, including every doctor who has ever worried about arousing suspicion by prescribing the wrong drug to the wrong person in the wrong quantities. Right and wrong in these situations are judged not by what is medically appropriate or what is best for the patient but by what is least likely to attract the government's attention. The safest course is to err on the side of undertreatment, which means treating patients' complaints skeptically and dispensing narcotics grudgingly if at all.

[Thanks to Siobhan Reynolds for the link.]

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  1. Chilling effect, medical marijuana, etc.
    These are various attempts to get the camel’s nose under the tent of ending the war on drugs.
    Call me simple-minded, and you won’t be the first, but the full monty issue is: Do we own our bodies, or not?
    If we do, we abolish the war on drugs, abolish the FDA, abolish prescriptions.
    In other words, we COMPLETELY legalize all drugs, period.

  2. The insanity of the war on drugs has no bounds. From preventing people from receiving treatments that will work for them, whether opiates for pain or marijuana for cancer treatment induced nausea, to the fact that we will let someone who murders you for your car out of prison in 10 years but someone carrying a block of pot gets life.

    The DEA obviously must downplay the horrors it inflicts on society to justify its Nazi existence.

  3. Couldn’t agree more Kira.

    I met an ex-DEA agent here where I work and fell into a rather heated debate one day while out on a smoke break (I pointed out that irony to him of course). He just would not accept the FACT that the drug war itself is the worst aspect of the entire farce. He conceded much ground when I pointed out that despite interdiction efforts importation continues apace. But he still felt that it was the government’s “moral duty,” to fight the drug war. I asked him if the agents who fought the booze trade in the 20’s felt the same way? He understood what I meant but wouldn’t take the bate. What I learned from our conversation was simply there are people, much like religious fundamentalists, that will, despite mountains of countervailing evidence, believe they are doing the “right thing.”

  4. Think there will ever be drug war tribunals? I can see the defense of some agents now, “I was destroying their lives and ripping their families apart because it was the moral thing to do. It was also my understanding that pot causes; teenage pregnancy, kids killing themselves by playing with their parents loaded guns, drive-thru customers running over little girls on bikes, and evil terrorism!”

  5. As a chronic pain patient who was finally lucky enough to find a good, reputable pain doc who is willing, and not afraid, to prescribe what it takes, I’d like to take the whole of the DEA out back and shoot ’em… and not up, y’know!

  6. A few years back I had some minor surgery, and was prescribed vicodin for pain. After taking 1 pill, I found I had an alergic reaction to it. When I called my doctor, he told me to just take ibuprofen instead.

    I was mad because I believed he thought I was trying to scam some more meds, when truly I just assumed I needed something strong for pain. The weird part? The ibuprofen worked fine which makes me wonder what the hell the vicodin crap was all about in the first place. Nevertheless, what if I had truly needed something for the pain, but had to tolerate this bozo refusing because he thought I was scamming.

    Solution? Legalize all drugs, period. Turn the doctor’s role back into an advisory one.

  7. Mmmmmm, Vicodin, makes me so sleepy, (yawn). Can I have another handful?

  8. RUTHLESS: Do we own our bodies, or not?
    If we do, we abolish the war on drugs, abolish the FDA, abolish prescriptions.
    In other words, we COMPLETELY legalize all drugs, period.

    SinC: Absolutelee-doodalee. Consider that my diabetic wife – like all diabetics – must have a scrip to receive insulin.

    Why?

    And in most states she must also have a scrip to get syringes, which is equally absurd and intrusive.

    We were in New York last month and a RiteAid pharmacy refused to sell her syringes, even though a law passed in 2000 permits participating pharmacies (with the ESAP program) to do just that. We didn’t have a list of approved pharmacies and only learned upon return to Florida that this RiteAid and most all pharmacies in the state are in the ESAP program.

  9. A couple of years back I was having a spate of anxiety attacks and I went to see my PA. He prescribed Xanax and they seemed to do the trick, but since he only gave me a prescription for 15 pills, after a few weeks I ran out. And you know what? The anxiety attacks still occured but I was afraid to ask for more medication fearing that my doctor would dissaprove. So the chilling effect works not only on the medical establishment but on the patients as well.

  10. I have a diabetic cat that receives two shots a day. More often than not, I pick up an entire box of needles in the Walgreens or HEB drive thru without a perscription. 🙂

  11. Mason, are you saying animals have access to drug paraphernalia in this great land, but humans don’t?

    And what’s with cat food? Just as nutritious, but much cheaper than our food?

    Never realized PETA was the ruling third of the Trilateral Commission!

  12. To my understanding, most animal things are much less regulated.

    Paladin Press had a book about this out back in the day…

    -Robert

  13. They’re normal “people” insulin needles (and so is the insulin itself).

  14. EMAIL: nospam@nospampreteen-sex.info
    IP: 212.253.2.204
    URL: http://preteen-sex.info
    DATE: 05/20/2004 03:14:05
    ‘Of course’ is cyanide of the mind.

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