Pill Poppers vs. Pain Patients

This week the Office of National Drug Control Policy announced a "strategy to confront the illegal diversion and abuse of prescription drugs." The initiative will include prosecution of online pharmacies, increased monitoring of physicians' prescriptions, and "education" aimed at making doctors more suspicious of their patients--all of which will make it harder for people in pain to get adequate treatment. To justify the crackdown, ONDCP cites 6.2 million "current abusers of prescription drugs." The Washington Post refers to "the growing menace of prescription drug abuse," which "touches and harms more than 6 million Americans yearly."

The impression left by such statements is that all 6.2 million of these people have serious drug problems. But the number, which comes from the 2002 National Survey on Drug Use and Health, refers to people who reported any nonmedical use of prescription drugs during the previous month. It includes anyone who took Ritalin for kicks or popped a Percocet to relax. How many of these people could reasonably be called addicts?

The NSDUH does not report data on daily use. But in the 2003 Monitoring the Future Study, only 5 percent of the high school seniors who had used prescription narcotics in the previous month were daily users. The comparable figures for tranquilizers was 7 percent.

So the number of pill poppers with serious habits may be more like a few hundred thousand rather than 6 million. By contrast, the American Pain Foundation estimates that 50 million Americans suffer from chronic pain, much of it undertreated.

This is not simply a matter of numbers, of course. It also should count for something that any harm prescription drug abusers suffer is self-inflicted, whereas pain patients have no choice in the matter.

Comments

[Jennifer]

There is a popular T-shirt slogan among teenagers that I have noticed in some schools and malls: "Pain is weakness leaving the body." Ridiculous, of course, but I really think that the government, on some level, views pain (and other biological facts of life) as something that needs to be overcome through mental effort: Pain Management is a Triumph of the Will!

Seriously, think about our society's approach to pain and other physical needs: Pain must be cured without drugs, because only weak people need drugs. Sleep is not a physical necessity but a sign of laziness. The sex drive is not a hard-wired fact but a sign of sin and corruptibility.

I made those four jokingly callous comments to "Ayatollah," but I'd be willing to bet money that ONE of those statements perfectly sums up our government's pain-control attitude.

[Fred]

Jennifer,

Snarky, for libertarians, is good. We'd go nuts if it wasn't for snarky humor. Some people define it as lite bitching but it connotes humor.

[Jennifer]

Merci, Fred. I just thought of another hopefully-snarky comment that I will write here before going off to run some errands: "Drugs are like children--just because some folks abuse them doesn't mean it should be illegal to have them!"

Hyuk, hyuk, hyuk. If you don't find this amusing, then perhaps you should take some drugs.

[Ruthless]

Hyuk, hyuk, hyuk... and I think I'll have some drugs too.

[Brian]

I've said this before, but I'll say it again.

I've given up on fighting the drug war head-on. The sooner that the Feds start arresting and jailing middle and upper-class suburban housewives for popping percocet, the sooner voters will lose patience with the drug war.

The majority of this country simply doesn't see the libertarian perspective on this issue, because it hasn't hurt the majority of them personally. Start throwing otherwise law-abiding people in jail...especially those suffering from undertreated chronic pain...and I guarentee you'll see attitudes start to change.

[joe]

If I were a paranoid libertoid, Brian, I'd say that the Drug Warriors are not arresting middle and upperclass white suburbanites precisely because such an activity would end the federal gravy train.

But, being a liberal, I'll just say they hate poor people, city dwellers, and minorities.

[thoreau]

But, being a liberal, I'll just say they hate poor people, city dwellers, and minorities.

So do some libertoids, it sometimes seems to me. Maybe they have something in common with the government after all 🙂

[Jennifer]

Brian--
I agree with you; that's why I wanted Rush Limbaugh and Jenna and Noelle Bush to go to jail even though they never hurt a soul. But everybody knows that only dark-skinned poor people are criminal drug users; rich white folk have 'medical problems.'

[JimInNoVA]

Jennifer - It's not even a "medical problem" when it's a Bush, it's a "family concern" now. Boy, good thing, and here I thought crack rocks in your shoe were indicitive of a drug problem.

[victim]

Middle-class people get busted all the time. So do plenty of rich celebs. Even an occasional politician.

People understand the libertarian position on the issue. But if it's a choice between raising eveyone's taxes and hassling an occasional .08, guess which one people are gonna pick?

[Jennifer]

Victim--
Of course middle-class and rich folk get BUSTED (even the Bush girls did); however, they're not being prosecuted. Therein lies the problem. Hell, our own duly appointed President got arrested for drunk driving, but not a damn thing happened to him, because Daddy covered it up. What do you think would happen if some poor nobody like you got arrested for the same crime?

[Pavel]

"Drugs are like children -- You just can't do them in public."

Double Hyuk!

[victim]

Jen,

I can assure you they get prosecuted. There's more money in prosecuting them. This is especially true in rural areas. There may be bigger fish to fry and less hassle by accepting pleas in urban areas, but rural counties with no money WILL prosecute.

[victim]

And Jen, you don't have to ask the question, I know what I went through when I was prosecuted. And the day of my first hearing, dozens more like me were prosecuted, too. And I'm not a poor nobody, and probably neither are you; we're middle-class nobodies.

[joe]

Yes, if a cop in Minneola finds a gram of coke in a yuppie's car, the yuppie will be arrested and probably prosecuted. But that cop is about 1000x less likely to search the yuppie's car than that of a young black male. And the yuppie is likely to get sentenced to NA, while the young black man has a good chance of catching federal king pin charges.

[victim]

joe, you're so nineties. These days, there's money in searchin' them thar yuppies.

[Jennifer]

How, exactly, were Jenna, Noelle and George Bush prosecuted? Or Al Gore's kid? How much time did they spend in jail? I must have missed those news stories.

And by Bush's standards, anyone who has to work for a living is "Poor," which is why I reiterate that we are poor nobodies. You, "Victim" would not have been victimized had you been related to a politician or captain of industry.

[victim]

Jen, I agree that nobodies get prosecuted and the connected get out of jail free, but I disagree that it's a class issue. Obviously someone with more resources is going to fight the charges harder, but when the economy's not doing so hot governments get a little more nervy in prosecuting. Gotta make those numbers look good if you want more federal funding. When the economy's doing fine, then yeah of course the poor folk are the only ones who get nailed. Don't forget there's loads of money in NA, too. NA, AA, MADD... those are more akin to political action comittees than they are rehab assistance. If you don't believe me, dissect an AA or MADD pamphlet for bad science yourself.

[Jennifer]

Wait a minute--you agree that rich folk go free while poor folk lose their lives in jail, yet you say it's not a class issue? Then what is it?

I don't doubt that AA and that ilk make money, but that's another issue entirely. The fact is, when a rich and a poor person commit the same drug "crime," the poor person's life is destroyed while the rich person is scarcely inconvenienced.

[M. Simon]

The science on the connection between drug abuse and PTSD is getting stronger every day.

Now it may very well be that PTSD is not a recognized reason for taking drugs. But I question the fact that it is self inflicted.

People take pain relievers to relieve pain. Drug abuse is a made up idea so society can have a group it is allowed to feel morally superior to. Look at them damn hippies. No control over their appetites. Tsk. Tsk.

The attacks on people in pain are not an abberation. It is the drug war - top to bottom.

[dhex]

one of the reasons nyc drug delivery services are so successful and hard to knock down (outside of heavy demand due to convience, laziness and relative ease of lawbreaking) is because they employ mostly white kids who look like college students on bikes. the cops pay them no notice and it's very rare that you read about a pot delivery service going under due to something other than "competitive practices." and i'm sure some of these groups are making stupid amounts of money, enough to have switchboards and relatively complicated operations.

also, the cops have better things to do than whack at overpriced nickle and dimers, like go after the coke and ecstasy delivery services. you can bet that when hammers fall on wall st. (like they did three or four years ago now) even people who were buying thousands of dollars of all sorts of chemicals every week from UC's did not, overall, have the same exciting experiences someone of lesser means would. this is despite new york's wonderfully draconian rockerfeller laws.

a good lawyer is worth his weight in gold. it's partially race, partially class and an awful lot about how many resources one has available to them at the time. and knowing not to talk to cops until that gold-weighted lawyer shows up.

[victim]

Jen, you overstate what I said, but I'll let it go. Your last statement is closer to what I see, but that that is not what your post at 2:57 suggested.

I never claimed the resulting circumstances of the punishments were proportionate between the classes, but the punishments themselves (and the frequency) are equal. It's conjecture to say that the poor guy gets prosecuted more than the middle-class and rich, but my experience shows that not to be the case. What my experience does show is that the equal punishments are a drop in the bucket for the rich, but they create compounded problems for the poor. The rich don't often "get off", I'd even bet that the Bush girls had to pay a fine (covered by Daddy no doubt, and the arresting officer might be looking for work now). Yes, for them a fine is like getting off for almost nothing, for the welfare mother the exact same fine is the beginning of a series of economic hassles, it's the compounding economic hassles (often resulting in additional legal hassles) that screw the poor guy.

I won't deny that there are biases on the part of police officers and who they bust. The ones joe mentioned above are only the tip of the iceberg, and they vary by time and place. When the coffers are low, bust everybody; when the coffers are flowing, just nab the "suspicious characters". Prosecutors are like everyone else, if they've got bigger fish to fry, they won't waste their time with piddly common stuff, in rural areas where there isn't much going on, any bust is a revenue stream.

[David]

Pick holes in one dodgy statistic, but take another one as gospel eh?

[joe]

"But the number, which comes from the 2002 National Survey on Drug Use and Health, refers to people who reported any nonmedical use of prescription drugs during the previous month. It includes anyone who took Ritalin for kicks or popped a Percocet to relax. How many of these people could reasonably be called addicts?"

They didn't call them "addicts." They said they abused drugs.

The drug was is fucked up. You know what else is fucked up? Teenagers using opiates recreationally.

[David]

I should have been allowed to post the first comment.

It aint fair!

REBEL HELL WARRIORS RULE! ROCK HARD AND RIDE FREE BIG MOMMA!

[The Big Pooface]

YA MOMMA IS A TRANNY!

[dj of raleigh]

> menace of prescription drug abuse," which "touches and harms more than 6 million Americans yearly."

Why stop at the ones altering their personalities
with the drugs, for it affects those around them too.

[rst]

Teenagers using opiates recreationally.

If they took on the teenagers and left us taxpaying grown-ups alone, we'd probably even help them out.

Just so that you're clear, opioids aren't all that bad for you. A "recreational" usage is no more than a t.i.d. p.r.n. prescription, and likely far less. Recreational usage is not The Problem, any more than a 17-year old who drinks a few beers and never drives during that time is not The Problem.

It's harder to get (and keep) painkillers than you think, especially opioids. Inspector General Offices throughout the entire country already crack down on pain management doctors. Patients on opioids undergo urine tox screens. If they fail, their medication is discontinued. If they run out early, they don't get early refills. Tracing a patient back to a doctor is easy...when they land in jail or rehab, the doctor is fined. This is already cracked down on, a great deal.

Election year...time for the gov't to start pretending they give a shit about your ill-behaved bastard children.

[Warren]

"You know what else is fucked up? Teenagers using opiates recreationally."

Thanks for the enlightenment joe. That surely is all the justification necessary for drug prohibition. Because if 50 million Americans have to suffer for the sake of even one of our precious teenagers, it's worth it.

I'm sure you think it's self evident that teenage recreational drug use is "fucked up". But what I think is "fucked up" is the proposition that on their twenty first birthday, every young adult will suddenly become a mature adult and make only wise decisions. It's important to learn about drugs before one obtains all the freedoms and responsibilities of an adult. Not all of that education can comes from books.

[joe]

If you try really, really hard Warren, you might be able to imagine a political viewpoint that doesn't approve of the drug war and thinks it's unwise for 17 year olds to use Oxy for fun.

Freaking jihadists on every side.

[jim]

I'm a disabled vet who lost a chunk of my leg in the first gulf war. I have a hard time getting Percocet because my doctors at the VA don't want me to become an addict while I'm only in my 30s (presumably no problem if I was in my 60s). They would rather I limp around in near constant (but to them, tolerable) pain.

[J. Alexander Lowman]

I think Warren is trying to say that kids should be told the truth about drugs and alcohol and not lied to so when they become "adults" they can actually act upon real knowledge and not lies and deceit.

But it is just more proof of how the government doesn't really care about it's people when it considers a few "abusers" enough of a problem to warrent denying relief to people who suffer.

[joe]

jim,

quit your bitching. your constant pain is a small price to pay if it prevents a teenager from using these drugs for fun.

[Jennifer]

If the government really gave a damn about teenagers destroyed by drugs it would stop worrying about OxyContin and focus on the way Prozac, Paxil and Ritalin are used to replace discipline, self-control and family time. Remember: recreational use of OxyContin is a CHOICE, but taking those prescription mood-changers often is not.

This is just like the idea of suing cigarette companies over lung cancer or McDonald's over lardasses: people with self-control must be penalized so others need not develop any.

[s.a.m.]

I think Warren is trying to say that kids should be told the truth about drugs and alcohol and not lied to so when they become "adults" they can actually act upon real knowledge and not lies and deceit.

More kids actually know the truth about drugs far more than the drug warriors want to admit. Thats a troubling factor for them warriors, kids are too young and innocent to be concerned about them "dark and scary drugs." Hence, the warriors need to crackdown further. Arrest more parents, that will show them kids just how bad those drugs really are!

[Jennifer]

I know that schoolteachers are not allowed to tell kids the truth about drugs. God forbid I tell a high-school student what he already knows from experience: that one puff of a joint will not turn you into a mindless zombie rapist. Now I tell kids the straight-out truth: "Drugs are dangerous because they can lead to prison sentences in excess of thirty years. The safe thing to do is wait until your twenty-first birthday and then drink until you puke."

[jim]

Joe,
I'm sorry to wallow. I'm sure there will be hundreds more like me in the coming months.

[joe]

Jim,

You're not wallowing, I didn't write that obnoxious comment (the email provided is "notreallyjoe"), and you're right about both the problem of gun-shy doctors, and the likely increase in wounded vets.

[Ruthless]

What if the only way to get to heaven would be to jump four feet across a bottomless crevice?
Completely legalizing all drugs would be heaven, but who will make the leap?

[thoreau]

Jennifer-

I know quite a few people with ADD (I come from an interesting family) as well as a few people who don't have ADD but were diagnosed with it anyway.

A person with real ADD is like a person with real depression: Their behavior isn't just a little wild (or a little sad, in the case of depression), it's something that is completely out of this world. And the person who has it generally realizes, at least in his or her calmer moments, that something is truly fucked up. And while the person with bogus ADD or bogus depression probably wants everybody to know "Hey, I have a mental illness, you have to make accomodations for me", the person with a real problem knows that something is fucked up and is just praying that nobody will find out. Since most people with ADD respond well to a combination of medication and behavior modification (the part of the therapy that requires active parents, gasp!), the odds are that such a kid will show up in your classroom with few signs of ADD if the parents remain involved.

The ones who show up in your classroom with a note saying "Johnny has ADD, so give him special help" usually have bad parents. Either the kid has real ADD but the parents aren't willing to do anything more than give him a pill (all the pill does is make the kid more susceptible to the effects of good parenting, it doesn't do the job for the parents), or else the kid has no medical problem, but the parents want a doctor's note to excuse themselves. Ironically, if a kid has no medical problem, the Ritalin will probably make the kid worse, not better. For normal people Ritalin is a stimulant, but for a select few with strange brain chemistry it actually calms them down. In my opinion, that is strong evidence that for a select group of people there is some strange chemistry going on.

An interesting study a few years ago found that it is both under-diagnosed and over-diagnosed. The researchers applied the most stringent criteria for ADD (as opposed to the ones used by pharmaceutical salesmen) and applied them to a group of kids. They found that a lot of kids having the symptoms weren't being treated (although some were), but a lot of kids who didn't have the symptoms were being treated anyway. Basically, on the one hand there's a lot of people who use bogus ADD diagnoses as an excuse for bad parenting and a way to get special treatment. Those people create justifiable suspicion of anybody who claims to have ADD, so other parents become deeply skeptical of the diagnosis and resist treatment.

Screwed up, no?

[rst]

prevents a teenager from using these drugs for fun.

This is the job of parents. Don't blame the rest of us if you can't control your children.

[Pavel]

As both a person with chronic back pain (triple fracture about a year ago) and an occasional prodigious user of recreational substances, I can say unequivocally that it is easier and cheaper to go to an underground black market source to treat my pain than to pursue medical help.

It's a bad situation becoming worse.

[Fred]

"...people with self-control must be penalized so others need not develop any." Jennifer

Snarkiest comment yet. We could win the White House in '04 with that as our slogan. Except that we would say it in a sincere tone, 'cause that's what people really want.

And the best word used on this web site has to go to rst for maloprocolypse to describe Dubya's forceful but malopropistic style of speaking.

[Jennifer]

Thoreau-
I don't deny that ADD or depression exist, but I doubt it's as common as the pharmaceutical companies would say. In the school where I used to teach, here are some of the behaviors that would get a kid diagnosed:

--being a seventeen-year-old boy who prefers daydreaming to listening to a monotonal lecture on Shakespeare's use of iambic pentameter

--being a fifteen-year-old girl who is depressed because her boyfriend just dumped her

--being a teenage boy of any age who finds it difficult to sit still for eight hours

What truly frightens me is the unspoken idea that a mentally healthy person is one who NEVER experiences unpleasant emotions, never feels sad, never loses her temper, and most importantly, never, ever irritates someone in authority. Personally, I would be more worried about the teenage girl who doesn't care when her romance goes bad, or the teenage boy who won't admit that some school subjects interest him less than others.

Last year one of my more intelligent twelfth-grade girls swore me to secrecy and then confided that sometimes she got very worried or depressed about the future--you know, going to college, choosing a career, "What-if-I-can't-cut-it-in-the-real-world," all the huge stresses high-school seniors have to deal with. I told her that this was perfectly normal, and I said "Anybody your age who says she isn't at all worried or nervous about the future is either lying to you or lying to herself. . . .every human being in the world is secretly plagued by self-doubt from time to time."

The girl was shocked and relieved to hear this, and though I was glad to help her I was also disturbed by the fact that an intelligent student in the year 2003 would honestly believe that being worried or scared or insecure sometimes is abnormal. The girl talked to me instead of a guidance counselor because she was afraid the GC would put her on Ritalin or something. And she was probably right.

[Jennifer]

Fred--
Does 'snarky' mean good or bad?

[Ayatollah Usoe]

I'm typing this with a broken hand. The doctors are so caught up in drug war hype that they believe drugs are addicting. So I'm using anti-inflamatories which can indirectly reduce pain. I'm also taking drugs prescribed for my wife to help sleep with the pain. Is that non-medical use? It's certainly illegal. I resent the idea that a doctor looking at me for five minutes can tell what I need, while my living in this body 24/7 is insufficient, and I need his permission.

Jacob, thanks for sending me your book, "Saying Yes."

[thoreau]

Ayatollah-

In all likelihood the doctors can tell that you need more medication, but they don't want to lose their license to practice if a puritan with a badge and no qualifications doesn't agree.

[Jennifer]

Ayatollah-

To paraphrase something I read on the Evil Bastard's Rationalization Guild: "Bad enough to be dying of bone cancer; let's not add insult to injury by letting these people become drug addicts, too."

Or try Nietzsche: "That which doesn't kill you will make you stronger."

Or a sadistic drill sergeant: "Suck it up, you whiny maggot!"

Or the Catholic Church: "Pain is God's way of telling you you're a sinner!"

I trust this makes you feel heaps better.

[dagny]

The sad thing is, people who want to abuse pain pills will get them somehow, whether it's through the black market or just through finding a doctor without very many scruples, while other people who have legitimate claims can't. I also know a bunch of people (not necessarily abusers) who have huge excesses of stuff like Vicodin because they were given a HUGE amount after a surgery.

[Berio Marina]

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DATE: 05/20/2004 09:13:13
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