Drug Policy

The Government's Top Minds Are Working Hard to Make Painkillers 'Tightly Regulated Yet Easily Available'

|

Yesterday I noted a New York Times profile of Nora Volkow, director of the National Institute on Drug Abuse, focusing on her simplistic, reductionist view of addiction. I should have mentioned that she and her amanuensis at the Times, Abigail Zuger, also had some woefully misguided things to say about the conflict between drug control and pain control:

Prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances. "The challenges we face are much more complex," Dr. Volkow said, "because we need to address the needs of patients in pain, while protecting those at risk for substance use disorders."

In other words, these drugs must be somehow legal and illegal, encouraged yet discouraged, tightly regulated yet easily available.

How is that possible? It isn't. Because pain cannot be objectively verified, there is an unavoidable tradeoff between providing adequate treatment and preventing people from getting high. Even if you think the latter goal is a legitimate function of government, protecting one group of people from their own bad choices simply cannot justify forcing another group of people to live (or die) with horrible pain. Morally, this is a no-brainer: It is better to let 10 addicts trick doctors into prescribing them narcotics than to let one legitimate patient suffer needlessly.

That is not how the government, as channeled by Zuger, sees it:

Treating people with the prescription drug problems is particularly challenging, because, of course, for these particular drugs, physicians are the nation's pushers.

The number of prescriptions written for potentially addictive pain medications has soared in the last decade, reaching more than 200 million in 2010, Dr. Volkow said. Surveys asking teenagers where they get pills find that relatively few buy from strangers. Many have their own prescriptions, often from dental work. Even more are given pills by friends and relatives, presumably out of other legitimate prescriptions.

Doctors may be flooding the country with narcotics, but most have never learned much about pain control. Dr. Volkow said that some data suggests that medical schools devote considerably less time to the subject than veterinary schools do. The Obama administration addressed exactly this deficiency in April with a call for doctors to undergo special training before being allowed to prescribe some of the most addictive painkillers.

"Students and residents have gotten the message that pain is undertreated," said Dr. Mitchell H. Katz, an internist who directs the Los Angeles County Department of Health Services. "So they just prescribe higher and higher doses." 

The official narrative that emerges from the Times article goes like this: Doctors used to be unnecessarily reluctant to prescribe opioids, but now they are erring in the other direction. Therefore we need to crack down on prescriptions, because too many people are using these drugs for nonmedical reasons. But such a crackdown inevitably hurts people in pain, because it encourages doctors to distrust their patients.

In an April column, I argued that the Obama administration's anti-diversion recommendations would limit access to pain treatment. More on pain treatment here.

NEXT: Ask a Libertarian: "What do you think about fiscal conservatives who are also social conservatives?" #3

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Obeymecare; fostering intrusion between medical professionals and patients by professional bureaucrats who are acting in my best interest as a citizen. How I look forward to the day Obeymecare is declared Unconstituional and the Government gets out of healthcare altogether (including eliminating the FDA)!

    Government bureaucrats understand nothing about pain untill it is inflicted upon them personally (as in layoffs of government workers due to no money – then they want drugs to ease it). What is tolerable pain for me may be abosloute torture for you. Pain treatment should be between a doctor and patient and no one else.

    Also, what do you do in my case, when I am allergic (anaphalyactic style) to non-narcotic NSAIDS? Frankly, I can use either acetominophen or opiates to control pain only; and acetominophen in high doses is hepatotoxic (liver poison). Since prophoxyphene (Darvon) was removed from the market it is now straight for the Hydrocodone. While hydrocodone works, the local physicians are rather stingy with prescriptions for it since the local media is trying their best to convince the public that it is the #1 cause of teenage suicide and addiction.

    Bottom line, the government and media want you to suck it up and suffer in the hurt locker so no one else can access your pain relief and recreate their central nervous systems.

  2. A National Institute of Drug Abuse is like a National Institute of Running with Scissors.

    1. Dude, we’ve all gotta learn somewhere. Would you rather learn how to roll joints or load a bowl from your drug-addled friends, or from teh government?

  3. Morally, this is a no-brainer: It is better to let 10 addicts trick doctors into prescribing them narcotics than to let one legitimate patient suffer needlessly.

    The vermin that dispute this need to receive a graphic demonstration, upon their own carcasses, of just what pain is really all about.

    1. I’m trying to figure out how the nerve induction box from Dune works.

  4. It’s good to know that the aristocracy (politicians) and the priest caste (public health scientists) must increasingly control every aspect of our lives, for our own good of course.

  5. Doctors used to be unnecessarily reluctant to prescribe opioids, but now they are erring in the other direction.

    Bullshit. Doctors are still scared to death of getting banged up by the DEA, and many, many doctors flatly prohibit any patients with chronic pain, or painkiller prescriptions, from their practices.

    1. Absolutely. Young doctors coming out of medical school will try to give you anything but opioid painkillers even if you actually need it. I’ve had them try to give me every obscure NSAID under the sun in the hopes that I wouldn’t realize it was just a more exotic ibuprofen and would stop asking. It’s unbelievably annoying to have to keep pressuring them, and then if your rate of use is even remotely above “almost never”, they won’t renew the prescription.

      Fucking prohibitionist scum.

      1. Oh the pain, the pain.

      2. Knock on wood, cross my fingers, etc. I feel so very fortunate I have had no need to go to a doctor beyond a required check up since ’91 when I needed some stitches. Beyond ibuprofen, my pill consumption has been entirely recreational. I don’t like the attitudes of doctors when I don’t need them, I can’t imagine how insufferable they would be if I actually did need one.

    2. A friend of mine broke his ankle this winter. They gave him proper pain killers for a while, but eventually, even though he still had significant pain while doing physical therapy, his doctor refused to even refill his prescription for fucking Tylenol 3.

      1. That’s fucking awful. It really fucking is. Fuck ’em.

    3. I don’t blame them for being scared. Physicians have gone to prison for prescibing what the DEA decides to be too many narcotics.

      A friend’s wife who is an anesthesiology resident is considering specializing in pain management. No way in hell I’d ever consider that, 7-figure salary (really) be damned.

      1. You can, however, blame them for not getting their professional associations to do something about it.

        Congress will never act unless and until the AMA goes on TV and tells them to.

  6. It’s because of dipshits like this that my Mother’s final years of life were years of wrenching agony. Fuck those sorry assholes and their control freak bullshit.

  7. Hey, did Volkow and Zuger not hear? The War on Drugs is over! Drug czar Gil Kerlikowske said so himself!

  8. “physicians are the nation’s pushers.”

    Really? “Pushers”?
    The whole idea of the drug pusher is ridiculous anyway even when talking about illegal drug dealers. Nobody has to push drugs. People like drugs because, in the words of Richard Pryor, “drugs is good!”
    I suppose seeing drug users as victims is slightly better than seeing them as criminals, but it is still fucking stupid.

    1. We will never win the war on drugs because people want to get high.


  9. The Government’s Top Minds Are Working Hard to Make Painkillers ‘Tightly Regulated Yet Easily Available’

    Who could have predicted this?

  10. Prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances.

    A rare moment of honesty. So why are the prescription drugs permitted but “tightly regulated”, but the “controlled substances” are illegal, save for a select few “researchers”?

    The pharmaceutical companies have paid their tribute to the throne and have the royal charter to peddle drugs to public.

    But it’s all “tightly regulated”, of course.

    1. A rare moment of honesty. So why are the prescription drugs permitted but “tightly regulated”, but the “controlled substances” are illegal, save for a select few “researchers”?

      Because in the view of regulators, the schedule I drugs which are illegal have no medicinal value. Please ignore heroin.

      Unfortunately, they may be right within a narrow context of ‘medicinal’.

      But no matter, the fact that we can’t even get legal drugs without a huge regulatory body in the way suggests that legalizing any other currently schedule-1 drug is going to be a vertical cliff battle.

      1. And yet it happened with loperamide, which has made it all the way to OTC, without an act of Congress.

      2. Unfortunately, they may be right within a narrow context of ‘medicinal’.

        I disagree, especially if the definition of ‘medicinal” is still “to cure disease or relieve pain.”

  11. “”In other words, these drugs must be somehow legal and illegal, encouraged yet discouraged, tightly regulated yet easily available.””

    It needs to be well defined, yet ambiguous.

    Kinda makes me wonder how this person deals with life. I wanna cook chicken but it needs to taste like beef.

    1. Kinda makes me wonder how this person deals with life. I wanna cook chicken but it needs to taste like beef.

      Cook it in beef stock?

  12. Top. Men.

  13. “…protecting one group of people from their own bad choices…”

    I would add, “assuming you think those are bad choices”.

  14. Just would like thanks for special read. I have enjoy it with great interest. You must spend numerous time and effort to write. Keep up good job and definitely will stick your blog for more great posts

Please to post comments

Comments are closed.