Medicine

North Carolina Sheriffs Want To Know Who Is Taking Painkillers

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Wow, is this ever a terrible idea.

Sheriffs in North Carolina want access to state computer records identifying anyone with prescriptions for powerful painkillers and other controlled substances.

The state sheriff's association pushed the idea Tuesday, saying the move would help them make drug arrests and curb a growing problem of prescription drug abuse…

Sheriffs made their pitch Tuesday to a legislative health care committee looking for ways to confront prescription drug abuse. Local sheriffs said that more people in their counties die of accidental overdoses than from homicides.

For years, sheriffs have been trying to convince legislators that the state's prescription records should be open to them.

"We can better go after those who are abusing the system," said Lee County Sheriff Tracy L. Carter.

In addition to the obvious privacy, doctor-patient privilege, and Fourth Amendment concerns, a policy like this is likely to exacerbate the undertreatment of pain. The sheriffs argue that giving them access to the database will help them catch doctors who over-prescribe and patients who shop from doctor to doctor when they're denied access to painkillers. I'm sure there are examples of both misbehaving doctors and patients. But in the past, law enforcement officials' definition of over-prescribing has sharply diverged from that of pain professionals. High-dose opiate therapy, a promising new treatment for chronic pain, has basically been cut off at the knees because of high-profile cases in which DEA officials, U.S. attorneys, and state and local law enforcement with no medical training have taken it upon themselves to decide what is and isn't appropriate treatment.

And the problem is self-perpetuating. As more doctors leave pain management out of fear, those left feel pressure to take on more patients. And the fewer doctors willing to prescribe pain patients the meds they need, the more doctors legitimate patients need to see to get proper treatment. Both are consequences of bad policy. And both are then considered by law enforcement to be signs of abuse.

Letting cops go fishing in patient databases for these "red flags" is only going to make it all worse. Sure, they may well find a few unscrupulous doctors, and perhaps some people who are using doctors to feed an addiction. But one thing that's almost certain to happen is that doctors are going to become even more fearful that every script is going to be scrutinized. Which means fewer of them will be willing to write them. Which means more pain patients are going to suffer, despite the fact that there are drugs available to help them.

Jacob Sullum's great 1997 feature on opiophobia here.

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  1. Why the fuck should it even be the government’s business what drugs I’m taking?

    1. …for the children ?

    2. Public health accomplishments should not be rolled back.

    3. They need to protect their property.

  2. Having the government control what you can put in your body is the price we pay for civilization.

    Now bend over for your cavity search, and don’t whine about it, parasite.

  3. Don’t abuse the drugs and it won’t be a problem. It is not an issue for someone who needs an occasional prescription, but no one should use addictive drugs long term. The risk of addiction is too great.

    1. “Don’t abuse the drugs and it won’t be a problem.”

      A problem for who ?

    2. Joe, I take it that you have never experienced chronic pain that lasts for years. If my choice is addiction or pain that makes life unbearable, which should I choose? And who the fuck are you to tell me what risks I can or cannot take in the first place?

      1. I actually agreed with Joe after the first sentence, then he went over the edge. As far as I’m concerned, addiction is no big deal when it comes to legitimate chronic pain. It is no worse than being addicted to coffee, in that it serves a purpose with one side-effect that is not creating any potential health risks.

        Addiction to pain-killers is just that: addiction to pain-killers. It does not cause cancer. It does not kill brain cells. It does not cause any physical harm to the addicted. It is simply the body saying, “YES! Give me more of this because it stops the fucking pain.” WTF is wrong with that?

        Now, as far as abuse goes, that is another story. Abuse, to me, means using a drug in a way not intended by a physician that can cause physical pain to the user or someone else. Someone popping oxycontin for kicks while beer-bonging is abusing a drug. Someone taking oxycontin until addicted to eliminate chronic pain is not.

        1. Popping an oxycontin while beer-ponging is abuse, but beer-ponging isn’t? Why? Please explain, because I’m curious.

          1. I think it is abuse because it is not being used for it’s intended purpose. If a Dr prescribed it to be taken orally with 12 oz. beers through a funnel, then I stand corrected. (You may be confusing beer-bong with beer-pong. While one usually ;eads to another, they aren’t the same thing.)

            1. What the fuck does a prescription have to do with it? Aren’t you “abusing” alcohol when playing beer pong? Under-21-year-olds don’t have a “prescription” from the government when playing beer pong; is that not using alcohol for its intended purpose?

              You seem to be one of those people that thinks that prescription meds are drugs in ways that say, alcohol or tobacco, are not. Which is, frankly, bullshit, and a product of the drug war. Consider yourself brainwashed.

              1. Since you put it in such simplistic terms, I guess you’re right. I guess it’s an issue I’ve not put a lot of thought into since I’m not under 21 and my kids are t young to drink (10 and 12). I’ve always looked at it through the prism of being regulated to a certain degree by the prescribing physician. Since people can self-prescribe alcohol, I didn’t consider there to be a similarity.

                Your points are all valid, and while I don’t consider myself to have been brainwashed, I now believe I was looking at this from the wrong direction. Thanks for getting me to see it from a different viewpoint.

                (I can honestly say there is absolutely no sarcasm in this comment. It is 100% sincere.)

                1. Well, I’m glad that you rethought it. It’s a difficult thing, because so many people do what you were doing: just knee-jerk reacting to the lifelong brainwashing. It’s a shame, because most people would be pretty rational about it without the brainwashing, which is why our government is even more culpable for all the shit that happens because of the WOD.

        2. Opiate use is actually linked with constipation, which can be a health risk if not dealt with properly. Thankfully, though, you can deal with it by either either more fibrous foods or taking laxatives.

          1. Exactly. If used properly, it may lead to addiction, which is not abuse. I think Epi missed my point there. The abuse puts others at risk potentially, and is also a crime. It can cause the abuser to lose control of his decision-making and put others at risk, and when it does this, the person is committing a crime. Not when he may lose control, but when he actually does. Of course, i’s the resulting behavior that is actually the crime and the abuse is just the cause of that behavior, so I may be a little off the libertarian reservation here, but I think if you use prescription drugs for a use not intended by a physician, you are committing a crime. That said, physicians need to have much more leeway in what they prescribe drugs for, but I fault that as much on overregulation and greedy litigants as much as anything.

            1. A little off of the libertarian reservation? Dude, you’re Andrew Jackson on this one.

              1. Please excuse my tortured indian metaphors.

              2. No shit; sloopy has bought the drug war propaganda hook, line, and sinker. How disappointing.

                1. Yeah, yeah, yeah. I had those comments coming. Please refer to what I posted above. Can I just say, “Uncle!” and get it over with?

                  I guess I was buying into the regulation thing too much, even if I was talking about regulation by prescribing correct usage (physician), not by government strong-arming (pigs/narcos), I took the self-determination away from the user of the product.

                  Also, I wasn’t proposing they arrest people for taking the drugs the wrong way. Looking back at my comment, I didn’t state what I was trying to very well, but either way, you guys called me out on it and proved (at least to me) that I was wrong on this one..albeit from lack of consideration more than anything else.

        3. Isn’t there a difference between being dependent on a drug and being addicted to a drug?

          1. Indeed there is. Anybody taking opiates on a daily basis for more than a few weeks is going to become physically dependent on them, and will have some uncomfortable symptoms if they stop suddenly rather than tapering off. That is not, however, addiction, which has a strong psychological component. This is why people taking them– at whatever dose is necessary– to control pain rarely become addicts. Addiction is mainly a problem for people who take them primarily for their euphoric side-effects. Even there YMMV, and anyway opiate withdrawal never killed anyone, unlike, say, alcohol withdrawal.

    3. Mind your own fucking business, and it won’t be a problem.

      1. It’s a version of the Juanita troll, dipshits. Ignore it.

        1. Mind your own fucking business, and it won’t be a problem.

          1. It’s a version of the Juanita troll, dipshits. Ignore it.

            1. I sense a pattern developing. Maybe it’s just the opium.

              1. Good evening. Tonight on “It’s the Mind”, we examine the phenomenon of d?j? vu. That strange feeling we sometimes get that we’ve lived through something before, that what is happening now has already happened.

    4. Mind your own business.

  4. Trollolololololololhohoho!

  5. As someone who has frequent pain episodes resulting from a past car accident (depending on how much I use the damaged joints, which is a lot if I want to run, play tennis, etc.), I can tell you that doctors are super fucking paranoid about prescribing even small prescriptions for painkillers. And we’re talking Vicodin and tramadol, not percocet or oxycontin, also.

    It sucks a lot.

    1. You’re just a big whiner. You don’t want to live in civilization. Grow up. The collective knows what’s best for you. And stop calling me a totalitarian!

    2. I am sure that your doc would give you a prescription for deepdishpizzacontin if you needed it.

      1. That causes nausea and diarrhea, and tastes foul going down. That would be very irresponsible of the doctor.

    3. And tramadol totally sucks, Vicodin is not far behind unless you up the dose and extract the poison from it.

      1. Tramadol is crap in terms of pain management, but take several of them and you get a great, speedy high that is a lot of fun recreationally. And it has no APAP in it either, usually.

        Vicodin actually works really well for me for pain, even in small doses, which makes it doubly annoying that it’s so hard to get it prescribed.

        1. Just steal Wilson’s scrip pad again and get back to abusing your staff.

          1. If only I had access to that much Vicodin. Which, by the way, would have destroyed House’s liver by now. Nothing like accuracy in a medical show.

    4. I can testify to this as well. I have a bad disk in my back. I can go for weeks, sometimes months without it slipping, but then I’ll do something seemingly normal, and be hardly able to breath, much less move due to the pain. It can last for a week or more. In the past, I’ve recieved Vicodin for the pain, which worked well. No buzz to speak of, but it did allow me to move around, and sleep at night. My old Doc retired, and the new kid I have is nice enough, but “doesn’t believe in” prescribing any narcotics short of terminal cancer patients. He wants me to take a fist full of Ibuprofen every day, because he doesn’t want to get in trouble for over prescribibg pain meds. Now I have sores on the lining of my stomach from the Ibuprofen, and it doesn’t stop the pain much. But at least I’m not getting my Doc in trouble. I DID try and get a new Doc, but was accused of “pain shopping.” I’m screwed.

  6. What about the HIPA privacy laws?
    I suppose they only apply to Nurse Shirley gossiping about you in small town America and not to Deputy Sheriff Barney blabbing all over town about your pain killers?

    1. Well, duh. We can’t trust private individuals with other people’s private information, but we should trust government officials implicitly.

    2. Deputy Fife is a public servant who puts his life on the line every day for everyone, including ingrates like you. So…you know…shut up.

    3. Law Enforcement Purposes. Covered entities may disclose protected health information to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if the covered entity suspects that criminal activity caused the death; (5) when a covered entity believes that protected health information is evidence of a crime that occurred on its premises; and (6) by a covered health care provider in a medical emergency not occurring on its premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.34

      http://www.hhs.gov/ocr/privacy…..index.html

  7. I think this is great — as long as I can check in advance on what I can prescribe. IOW “hey sheriff asshole I have a lady here with 8 rib fractures, how many percocet am I allowed to prescribe?” Let them take the liability if they want the power.

    Even better, let the drugs be OTC and leave me out of it.

    1. Sovereign immunity…so sorry.

  8. I bet you fundamentalists would be OK with it if an insurance company denied these people’s claims to get drugs for chronic pain.

    1. Bad spoof job. F+ at best.

    2. Generic opiates are usually the less expensive option. Kaiser patients have some of the best access around.

      I hope that isn’t giving anything away.

  9. I wouldn’t want to be a dog in North Carolina.

  10. How exactly do these sheriffs propose to prevent accidental overdoses with this information? Will they wait outside of each house with a syringe of adrenaline, just in case?

    1. By looking at patterns of prescriptions. Set a certain number of pain patients, number of prescriptions, or volume of medication, and monitor over time.

      Just observing physician prescribing practices will create a disincentive to prescribe. Presto, fewer injured patients. Of course, there will be unintended consequences (there always are). Then the sheriffs will come up with another patch to address the new problem.

    2. Naloxone is the antidote to opiate overdose, not adrenaline. But apparently the creators of Pulp Fiction didn’t think the audience would be smart enough to understand what naloxone is, so they called it adrenaline instead.

      1. They understood perfectly well. The movie showed the intracardiac injection of adrenaline to restart a stopped heart.

      2. BTW, that’s one of the most joyous scenes in movies to me. Same kick as in Frankenstein. I just love the depiction of the dead being brought back to life. By contrast actual births are ho-hum.

    3. Because after all their years in law enforcement, they are able to tell by looking at a person how much pain meds they should be taking.

  11. A certain percentage of the population suffers from pain. A certain percentage of the population will get inadequate relief from standard levels of care. A certain percentage of the population will become addicted to pain pills if they are available. A certain percentage of the population will kill themselves with pills.

    These groups overlap–it is inevitable that even proper medical care may lead to opiate addiction and death.

    The question is, is it anybody’s responsibility if someone becomes addicted or dies of an overdose? Currently, the physician is potentially on the hook; the patients themselves can have a significant loss of volitional control. Law enforcement will get involved when someone dies.

    Bearing all of this in mind, most people (not me, I should note) will think that this sort of invasion of privacy is justified. And pain patients will continue to suffer from actual pain and from the indignities of trying to get pain treatment.

  12. I would almost like to see this pass…temporarily. I would love to see the scandal that comes up when a sheriff decides to run for mayor and it “accidentally” gets leaked that his opponent just got prescribed viagra because he can’t get it up. That would be comedy gold.

    Either way, the backlash in public opinion was pretty severe based on the comments I read in the Charlotte Observer. There’s no way in hell this becomes law. It violates the 4th Amendment as well as HIPAA. It would be interesting to see it pass if only to see what the feds fight it (assuming they would) with. My money is HIPAA. Methinks they want us to forget what is written in the 4th, so they won’t bring that one up.

  13. Goddamn these evil men, goddamn them all. I seriously wish that every single one of them would develop a condition of lifetime agonizing chronic pain.

    1. Why?

      They’re all corrupt.

      Many of them are planning on retiring early on “disability” with full lifetime pension and plenty of pills.

      It’s not like the rules that they make affect them.

  14. Threadjack>
    Koran burning called off.
    Official score: 2nd Half
    Free speech 0-14 Paranoia

    1. But Westboro Baptist recovers the fumble and is now in position to score. This game ain’t over yet.

      And it looks like in the other game, Property Rights is getting beaten late in the game by religious bigotry. They’re lining up to punt the mosque to another site. It’s a sad state of affairs in lower Manhattan.

      1. As long as it is being worked out without government coercion I’m happy with the result.

        1. But you know there was government coercion. The WH issued a statement. The DoJ issued a statement. The FBI issued a statement. General Betrayus issued a statement.

          If that’s not government coercion and a chilling of free speech, then I don’t know what the fuck is.

          And as far as the mosque goes, I have no problem with the way it went down. I hope they don’t cave, but it looks like they will have to. Nobody wants to give them money out of fear, but there was no government coercion at least. What really sucks there is that fear-mongering and vitriol (all protected by the 1st in this case) won.

  15. Little thought experiment. Suppose tomorrow all democracy was abolished, and the world was governed absolutely by a wise man chosen for life by competitive civil service exam. In 10 years, think this problem is better or worse?

    1. Nobody wants to take me up on this one? What I’m getting at is whether people think this problem originates from the many or from the few — and whether it’s there because of experts or because the people rule.

  16. North Carolinians who suffer from chronic pain can always just start mainlining black tar. It worked for grandpappy.

  17. High-dose opiate therapy, a promising new treatment for chronic pain, has basically been cut off at the knees because of high-profile cases in which DEA officials, U.S. attorneys, and state and local law enforcement with no medical training have taken it upon themselves to decide what is and isn’t appropriate treatment.

    This completely blows my mind. Unlike, say, Tylenol, there is no ceiling on dosage effectiveness for opiates. With Tylenol, after a certain point, a larger dose won’t treat your pain any more effectively; it’ll just kill your liver.

    Patients on opiate therapy build up a tolerance. Depending on the level of that tolerance, there really isn’t a ceiling at which an opiate will stop being effective. Patients on chronic opiate therapy can take doses of morphine that would kill an opiate-naive patient; they need to take that dose because of their tolerance. This is basic physiology, biochemistry, and pharmacotherapy stuff. Are these untrained suits really taking it upon themselves to decide how much is enough? That’s awful. It’s cruel. It’s maddening.

  18. What a stupid fucking country filled with stupid fucking people. It amazes me how the vast majority of people have accepted the premise that the government can dictate what you may or may not ingest in your own body, not to mention having accepted hook line and sinker the hysteria over substances and the puritanical like/Carrie Nation like fear that someone might be feeling indecently good. And for chronic pain sufferers everywhere I want to say “fuck you” to all of those who would rather see us committing suicide than using the “crutch” of effective pain control in order to try to live our lives.

  19. Never mind the sheriffs. There shouldn’t be “state computer records identifying anyone with prescriptions for powerful painkillers and other controlled substances.”

  20. One of the great things about HIPAA is that it is a privacy regulation that protects your medical information from everybody except the government. It imposes minimal (at best) restrictions on any government agency taking a good hard look at your medical records. At most, all they have to do is file a little paperwork first.

    And if they can convince a legislature to pass a law, or go to the trouble of writing a regulation ,then they don’t even need to file any paperwork.

  21. “High-dose opiate therapy, a promising new treatment for chronic pain, ”

    Um.. It’s not a promising new treatment. It’s an incredibly old, highly effective treatment that fell out of favor. Partially due to abuse, partially due to changing attitudes.

    Chronic pain can be horrible. High doses of opiates have their well-understood problems. People with honest-to-goodness chronic pain need to have the ability to have intelligent discussions with expert doctors on what’s best, what works for them, and how to manage the problems that will arise from it.

  22. After a crackdown here in the 90’s, it’s a rare doctor who will prescribe any pain meds except the ones containing asprin/apap/ibuprofen which are much more dangerous than the opiate alone. I have heard of at least one person with chronic pain whose doctor advised them to claim addiction and go to the methadone clinic because he didn’t want the liability.

  23. It is pain relieving for me to find out that libertarianism is capable of growth and maturation, a living, breathing philosophy flexing with the times and willing to come out in such strong support for a medical system that inevitably produces dependency.
    A few bad docs out there…so what? The market will take care of them. A few deaths…blame them on Xanax. More and more deaths every year due to prescription opiates…don’t want to interfere with the physician-patient contract do we?
    As a physician treating opiate addicts exclusively I want to thank Mr. Balko and all the good folks at Reason for my job security.

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