Drug War

From the "Our Government Can't Afford to Spend a Penny Less" Files: Useless New Initiative on Prescription Drugs

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Details from Reason contributor Maia Szalavitz writing at Time:

The Obama administration announced on Tuesday a new initiative to reduce prescription painkiller misuse and overdose, a problem that has become the leading cause of death in 17 states, surpassing car accidents — and killing more than 28,000 people annually. The new plan includes increased funding for state prescription drug monitoring programs (PDMPs) as well as an FDA-led program to educate doctors about risks related to opioid painkillers…..

…..do drug monitoring programs work? If they are effective at reducing misuse and deaths, do they also reduce appropriate pain care? Not mentioned in the announcement of the White House plan was a relevant new study led by researchers at the Centers for Disease Control and Prevention (CDC), which compared rates of overdose deaths and prescribing in states with and without PDMPs between 1999 and 2005.

PDMPs collect information about patients' prescriptions in a database and make the data accessible to doctors, pharmacists and sometimes law enforcement. The new study, published recently in the journal Pain Medicine, found that such prescription monitoring had no effect on either overdose deaths or rates of prescribing…..

Advocates for pain patients worry, however, when they see large reductions in prescribing associated with monitoring programs. "The states where there are PDMPs indicate that fewer Schedule 2s are prescribed," says Siobhan Reynolds, a long time activist for pain treatment. "That means that the people with the most severe pain are bearing the burden of all these supposed safety measures."…..

Another difference between New York and Pennsylvania may involve the availability of naloxone, the overdose antidote that can be used to revive victims. Most people who overdose are not legitimate pain patients who mistakenly take the wrong amount, but people who misuse opioids with other drugs, in most cases mixing them with alcohol or other depressants like Xanax. Fully 70% of those who report misusing painkillers do not have their own prescription for them, but obtain the drugs from a relative or friend.

In the mid 2000s, New York State began a major initiative to provide naloxone to addicts at programs like needle exchanges, and to train them on how to save overdose victims. By contrast, Pennsylvania has only a few naloxone programs.

In Illinois, the Chicago Recovery Alliance has distributed more than 11,000 naloxone kits since 2001 — and more than 1,000 overdose reversals have been reported since then, along with a reduction in heroin overdoses…..

Naloxone has not been reported to cause harm if it is used unnecessarily. Its worst side effects tend to be withdrawal symptoms caused by reversing the overdose and therefore blocking the opioid's action on the brain.

But although Food and Drug Administration commissioner Margaret Hamburg acknowledged at a press conference Tuesday that naloxone might be part of the solution to reduce overdose deaths, use of the treatment does not appear in the strategy released by the administration.

The Drug Policy Alliance's reaction to the plan and its ignoring of the genuinely life-saving naxolone:

overdose prevention advocates were dismayed by significant omissions in the plan. Glaringly absent is any mention of a proven, evidence-based intervention called naloxone, an inexpensive generic medication approved by the FDA that rapidly reverses opiate overdose.

The action plan comes with a hefty price tag. ONDCP is requesting a $222 million increase in funding from Congress to implement it. "It's discouraging that the new plan ignores cost effective, proven solutions like naloxone and Good Samaritan 911 policies, while simultaneously calling for hundreds of millions of taxpayer dollars for unhelpful programs like prescription drug monitoring databases. It's described as 'comprehensive,' but in fact it's insufficient," said Meghan Ralston, harm reduction coordinator for the Drug Policy Alliance.

States such as New Mexico and Washington have already implemented Good Samaritan 911 policies, a no-cost solution encouraging people to quickly report an overdose to emergency medical professionals without fearing arrest for minor drug possession. Hundreds of college campuses across the country also have similar policies in place.

Reason on prescription drug monitoring here and here. Me on Arnold Schwarzenegger's idiotic veto of a good samaritan drug overdose plan in California. Jacob Sullum's 1997 classic on the monstrous effects of government obsession with people using "too many" painkillers.

NEXT: ObamaCare, the Necessary and Proper Clause, and U.S. v. Comstock

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  1. painkiller misuse and overdose, a problem that has become the leading cause of death in 17 states

    Let me guess – all GOP states like MS. AL, GA, SC, TN etc.

    I would pay to hand this shit out like candy and cull out the Stupid Party base.

    1. Pass it out in DC to Congress. Culling 535 people who live in a swamp is way easier than culling everyone who votes for them.

    2. shriek, you are the Stupid Party base. In fact, just like Rush is King of the Rednecks, you are Emperor of the Morons.

      Has it occurred to you yet that you are everything that you spew venom at?

      No wonder you’re such an idiot. Projection is all you are. Really, for the good of everyone, just kill yourself.

      1. You really would be an hero.

    3. For what it matters, here’s the definitive study. You can see that “Drug poisoning mortality varied 7.9-fold, from 1.6/100,000 in Iowa to 12.4/100,000 in New Mexico.”

      Here’s the map from another study.

      Actually, MS and GA are quite low, though not as low as the upper Midwest, such as Dakotas, Iowa, Minnesota, Nebraska. MS is lower than WI, though. The highest rate is in WV, followed by DC, NM, UT, NV, OK, KY, PA, FL, LA, TN, MD, AK, WA, and then ME. A mix of very loyal Dem states, loyal GOP states, and tossup states there.

      So your prejudice is unsupported by the facts. Unsurprising, since shrike is not only always full of hatred, but always ignorant of the facts.

    4. How do you go through life being so ignorant and stupid, shriek? Obviously by being proud of it and trying to insulate yourself from any facts or science, relying on only your good old prejudices and hatred.

    5. More pussy, Balko or O’Keefe? You know it’s O’Keefe did you see his video and all those sexy babes? Balko’s last piece of ass was Andrew Sullivan!

  2. an FDA-led program to educate doctors about risks related to opioid painkillers

    So this isn’t covered in med school already?

    1. Not to the degree it should be, really, but the solution to that isn’t for the federal government, who already charges us 500 bucks for a DEA tracking number which allows us to prescribe narcotics and that traces our prescriptions so that some bean counter in Washington can decide whether we’re drug dealers, to mandate a whole bunch of new training that will cause all of us to roll our eyes and fall asleep at taxpayer expense…although I’m sure they’ll eventually just charge us for that too.

      1. oh for pete’s sake. when used responsibly, the risks are tiny. when abused, well they increase. so what?

        i’ve been on high dose opioids after two surgeries. they work. well.

        all this crap does is make dr’s that much more scared to prescribe painkillers to people in sufficient doses out of fear of DEA scrutiny and that the person might be a drug seeker

        so, the actions of the drug seeker result in legitimate patients unduly suffering

        1. so, the actions of the drug seeker result in legitimate patients unduly suffering

          No, the drug seeker harms no one but himself. The actions of the government (and their enforcers) result in legitimate patients unduly suffering.

      2. Is this something that even needs to be covered in depth in med school? I mean, shouldn’t anyone in med school have enough common sense to already know that opiates can really fuck up dumb people who abuse it?

        1. Sure…of course we also cover the harmful effects of overeating too. The opiate thing is a big problem for us, because on the one hand we want to help get people out of pain, but on the other there is such potential for harm. The first thing we swear to do is no harm, after all.

  3. Fully 70% of those who report misusing painkillers do not have their own prescription for them, but obtain the drugs from a relative or friend.

    Reason doesn’t understand. This is what the government thinks it can fix with more controls.

  4. “a problem that has become the leading cause of death in 17 states, surpassing car accidents”

    Bullshit. Probably what they should have said if they were bothering to be factual was “the leading cause of accidental death”.

    1. That’s what I was thinking. No way is it the leading cause of all deaths.
      And, in a way, isn’t it a good thing that self inflicted overdoses are a leading cause of death? There are a lot worse things that could be causing a lot of accidental deaths.

      1. And even if that was true, it’s probably mostly cases of people who were very sick and didn’t have long to live anyway.

        1. 1. You’re assuming a lot there.

          2. Zeb’s comment makes sense. Drunk driving and other activities that can hurt others is a lot worse that dying by OD. Not considering of course the effect on the individual’s family, but we can’t hope to account for that to any degree anyway.

  5. I was under the impression that second-hand smoke was the leading cause of death to everyone everywhere.

    1. I thought it was global warming.

      1. I’m waiting for the link between second hand smoke and global warming. The warming will probably be made even worse by beer, porn, and barbeque.

  6. And how many of these overdoses are overdoses not on the opioid itself but on the shitload of acetaminophen the government encourages drug-makers to mix in with them?

    1. “The statisticians at MADD assured us that if opiods were even peripherally involved with the death, that we can count it as opioid overdose.”

      -The ONDCP

    2. Most of them, apparently.

    3. my dr was really kewl. i told him i wanted to avoid high dose NSAID (APAP specifically), so he prescribed mostly roxycodone (instant release oxycodone) and oxycontin, and less percocet.

  7. Should’ve heard the guy on “Coast to Coast AM” last night “explaining” that the reason some people can’t get sufficient pain rx is that the drug maker so heavily marketed OxyContin that it was overprescribed, leading to a crackdown, and that the only advantage OxyContin had over conventional oxycodone was the convenience of less frequent dosing, which was not a good enough reason to market it so heavily. And of course doctors were too dumb to realize they were being over-sold on it.

    Of course what he omits is that, far from its being a mere matter of convenience that a drug maker would unjustly promote to make a quick buck, the longer action of OxyContin (like MSContin for morphine sulfate) was promoted because it would be less likely to be “abused”, so doctors should have less fear of prescribing it. So it was just to try to get doctors to give as much in the way of narcotics as they wanted to and should have been giving to start with.

  8. doctors were too quick to prescribe painkillers, and they got caught profiteering-fuck ’em

    1. Rather, you’re an idiot. We don’t get paid any more for prescribing painkillers versus not prescribing painkillers. Please kindly go fuck yourself instead, if you can get your head out of the hole first.

  9. As a pharmacist, it is comforting to know that the FDA feels it can do my job better than I can. God only knows what this country could become without the EPA and FDA holding it back. They have a few useful functions, but on the whole they just enjoy fucking with the industries they regulate.

    Just like the black market for illegal drugs, the players in this market will not be stopped by the FDA. All this does is make things more difficult for legitimate practitioners attempting to control pain. Granted physicians only know about 30 drugs really well (yet still maintain a monopoly on prescribing by the state), they still don’t need a “re-education” campaign about painkillers.

  10. “FDA-led program to educate doctors about risks related to opioid painkillers”

    Really, FDA? Doctors don’t need your fucking bullshit.

  11. There’s some kind of conspiracy going on. For years all the experts have been saying narcotics are underused in the USA. In the past 24 hours I’ve heard or read:

    1. An author of a book or something putting himself as an advocate for consumers as against the profiteering drug industry, saying what I wrote above on last night’s Coast to Coast.

    2. This bit in Hit & Run.

    3. Some report on ABC News at midnight or maybe 1 AM EDT citing experts that the USA far overuses narcotics compared to the rest of the world (!) and that they should be used only for terminal pain, not for chronic pain.

    WTF is going on here? This can’t be coincidence. Suddenly the anti-narcotists are pushing back?

    1. It depends on how “use” is defined.

      I can only provide anecdotal evidence from pharmacists, but what I hear is the number of people with narcotic prescriptions is way way way up from 20 years ago, but the dosages are probably down a bit for some meds.

      What that tells me is lots of people are getting prescription meds even though they have no intention of using the stuff, or using only part of it and selling the rest.

      Ritalin is a schedule 2 drug – in a lot of minds that is a synonym with “narcotic”. Ritalin is a scam in rural areas – shitloads of welfare hicks are getting Ritalin scrips and they’re using the shit to supplement their incomes by selling it to Ritalin junkies. And the shit for brains popo’s still look for meth labs…

      1. I think the increase could be due to disillusionment with non-narcotic analgesics and with surgery. People are wondering which will be the next shoe to drop among the cyclo-oxygenase inhibitors. Plus there’s the aging of the popul’n, with more arthritis.

  12. I like the part where the government assumes it has the authority to monopolize, or even regulate, the manufacture and sale of drugs. That part really had me laughing. Until I realized it wasn’t a joke. Then I popped a few Vicodin.

  13. *Impose such burdens upon the manufacture and sale of drugs, or even regulate …

    Sorry. Half-sleep.

  14. painkiller misuse and overdose … has become the leading cause of death

    among those who misuse painkillers and overdose.

    1. Lmfao. Nice.

  15. Did these idiots ever consider the reason why narcotic RXs have increased is because doctors are now trying to correct the very serious problem of UNDERTREATED PAIN!

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