Prescription Drugs

Physicians Face Moral Dilemma In Conscription on War on Drugs

In the government's new war on opiates, physicians and their patients find themselves caught in the crossfire.



America's physicians have been conscripted as law enforcement agents in the never-ending War on Drugs, and it puts us in a moral dilemma.

As media attention has turned to the recent national surge in prescription-opioid and heroin abuse, politicians feel compelled to be ready with "solutions." The Obama Administration last summer announced $100 million in new funding for drug-addiction centers, and has recently announced new opioid training programs for federal government physicians. In a recent debate, Presidential candidate Hillary Clinton, exclaiming, "Lives are being lost," proposed a $10 billion criminal justice initiative including increased grants to states for drug treatment centers, as well as training and equipping first responders to administer heroin overdose antidotes. As a doctor, I react to these reports with great apprehension, because public policy will inevitably impact my profession and me.

Lessons From the First Drug War

With the passage of the Harrison Narcotics Act in 1914, opiates and cocaine for the first time were prohibited to the general public without a doctor's prescription. The Surgeon General reassured doctors that this was intended only as a means for the government to gather information. But when doctors began writing morphine prescriptions for patients (many of whom were affluent middle aged women at the time) as a means of helping them cope with their chronic addiction, they suddenly found themselves in violation of the fine print of the law: the doctor may prescribe "in the course of his professional practice only." This was interpreted by law enforcement to mean that these drugs could not be prescribed simply to help the patients avoid the pains of withdrawal from their addiction, and doctors risked indictment if they prescribed narcotics for this reason. The first War on Drugs was underway, and physicians found themselves caught in the crossfire. 

Six weeks after the Harrison Narcotics Act's passage, the New York Medical Journal warned in an editorial that the new law will have ominous consequences, including "the failure of promising careers, the disrupting of happy families, the commission of crimes that will never be traced to their real cause, and the influx into hospitals for the mentally disordered of many who would otherwise live socially competent lives."

Critics of the War on Drugs like to use alcohol's prohibition and its subsequent re-legalization as a teaching tool for making their case. Alcohol is an extremely dangerous drug. Overdosing on alcohol can lead to coma and respiratory arrest. Long-term addiction can cause liver failure, gastrointestinal hemorrhage, cardiomyopathy and heart failure, pancreatitis, cancer of the stomach and esophagus, cognitive disorders, encephalopathy, and dementia. It didn't take long for the public to learn, however, that the destruction to society wrought by alcohol prohibition far outweighed the harmful effects of alcohol on the segment of society who could not use this drug in a safe and healthy way.

Fortunately, a doctor's prescription was never required for people to obtain alcohol. Such a requirement would have created a real moral dilemma for the physician: should he help the patient avoid the pains of alcohol withdrawal by writing the prescription? Is prescribing alcohol for that reason an appropriate one in the eyes of law enforcement? Furthermore, will prescribing the drug contribute to the patient's harm over the long term and thus violate professional ethics?

Opiates, by comparison, are much safer than alcohol. Long-term addiction can contribute to gastrointestinal motility and digestive problems, and research suggests it might slightly impair the immune system and promote mild hormonal dysfunction. Some studies have shown chronic use increases the risk of clinical depression, and might make users withdraw socially. There is no conclusive evidence that it can cause dementia or cognitive disorders. There is an honest disagreement among health care practitioners over just how harmful long-term opiate use can be.

So it would appear that prescribing opiates to an addict to help him avoid withdrawal would present less of a professional ethical dilemma than with alcohol. And the practitioner who doesn't feel it is ethical to subject the patient to the risks of long-term opiate use—even with the patient's informed consent—can always refer the patient to a doctor who doesn't see an ethical problem. Alas, that's not how things worked out.

Doctors began to cut their patients off from narcotics, fearing federal prosecution. Patients would "doctor shop," feigning painful illnesses, and when that didn't work, would turn to the streets to buy their opiates in the burgeoning illegal market. At first they purchased morphine on the street. But after heroin (diacetyl-morphine) was outlawed entirely in America in 1924 (it remains legal and is used in hospitals in Britain and other European countries under the name "diamorphine"), drug dealers pushed heroin over morphine. By the close of the 1920s, the great majority of opium addicts were now heroin addicts.

Opiophobia Onset | For More: See Reason's classic 1997 cover story No Relief in Sight

As the drug war intensified in the 1970s and onward, doctors became ever more leery of prescribing narcotics. And patients in pain became more fearful of taking them as they heard more horror stories about addiction. By the late 1990s, a new term was coined, opiophobia, to describe an irrational fear of opiate prescription and use by doctors and patients.

As professional and patient advocacy groups became more enlightened on the topic, however, patients were encouraged to overcome their fear of addiction, and doctors were exhorted to show more compassion and prescribe more liberally. By the dawn of the 21st century, narcotic prescription—and narcotic addiction—began to rise again. 

In the past few years, a surge in opioid prescription use and opioid addiction has been noted with alarm by public health authorities. In response, the U.S. Drug Enforcement Administration (DEA) has partnered with state medical and pharmacy licensing boards and state health authorities in an effort to curb opioid prescription and root out "pill mill" practices.

Prescription Drug Monitoring Programs (PDMP) now track the prescribing patterns of health care practitioners as well as monitor the frequency and amounts of prescriptions filled by patients. Doctors are provided with periodic "report cards," comparing their prescribing patterns with their peers. In some states legislation is being considered to require prescribers to check on their patient through the PDMP before writing any opioid prescription. And law enforcement, often using undercover agents, have severely cracked down on providers they believe are over-prescribing.

This has chilled the behavior of many prescribers, who are beginning to revert to the old practice of cutting patients off.

History Repeating

According to the Centers for Disease Control and Prevention (CDC), heroin use in the U.S. has increased 63 percent over the past decade, while prescription-opioid abuse has also risen. In fact, 45 percent of heroin addicts are also prescription opioid addicts, the report claimed.

Addiction rates are up among both the affluent and people with health insurance. The CDC found that people in these groups tend to move on to heroin after being cut off from prescription opioids. (Sound familiar?)

Bree Watzak of the Texas A&M College of Pharmacy states in a 2015 report: "We see that people tend to move on to street drugs after they've lost access to prescription opioids. It's a progression."

Thomas Frieden, director of the CDC, said in a July 2015 interview with NPR that people who abuse prescription opioids are 40 times more likely to abuse or become dependent on heroin. He also lamented that heroin is more available than ever on the streets, and often far cheaper than prescription narcotics. In fact he estimates heroin to be one-fifth the cost of prescription drugs. This more than 50 years since President Nixon declared the second "War on Drugs."

So 102 years after the passage of the Harrison Narcotics Act, and 92 years after the banning of heroin in the U.S., here we are.

Short of ending the War on Drugs, there are steps that can be taken in the right direction. One is called "harm reduction." If a heroin addict is unwilling or unable to detox and undergo rehab, then at least provide clean needles with pharmaceutical grade heroin so as to avoid the spread of disease and enable the person to lead a more productive life. Programs like this in Switzerland, the U.K.,and other countries have been successful, and many addicts have been thus able to resume their occupations and a relatively conventional lifestyle. They no longer have to spend their days looking for the drug and they take just enough to be able to perform their jobs without experiencing withdrawal symptoms. Many, after returning to a conventional lifestyle, gradually taper themselves off the drug and voluntarily detox.

Another smart move would be to "decommission" doctors as agents of law enforcement. Allow doctors to prescribe opioids without fear of prosecution. A physician who encounters a patient with a dependency problem should have a frank discussion with that patient, inform the patient of the potential long-term health consequences of the addiction, and encourage treatment of the addiction. If the patient refuses treatment, then the physician can continue to write the opioid prescriptions in the interest of harm reduction—it certainly is preferable to patients going to the street for heroin and dirty needles.

It has been over a century since the government began its first War on Drugs. It set in motion a series of destructive unintended consequences affecting every one of us, and the medical profession has not been spared. We learned before that the harmful consequences of alcohol prohibition were worse than the drug itself. It's time we learn to apply that same insight to the other drugs, including narcotics. 

NEXT: The Case of the Catfish Cartel

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  1. Tooth for tooth, eye for an eye
    Sell your soul just to bop on by
    Beggin' for a dollar, stealin' a dime

  2. "As a doctor," writes Jeffrey A. Singer, "I react to these reports with great apprehension, because public policy will inevitably impact my profession and me."

    This illustrates how little doctors care about people and their well-being!


  3. This is just like the government forcing banks to look for "structuring" and far more. It's just another stealth tax/taking/theft from the host that the parasite does. It doesn't have the money and resources to police opiates the way it wants to? Enslave doctors to do it for them, and people don't see it as taking money/tax/theft (for some idiot reason), and they get away with stealing even more of someone's productivity.

    The government is an exceptional parasite. It can find endless ways to drain off the host.

    1. I have a son who is going to be starting on a pharmacy degree next year so I have been talking to acquaintances who are in the pharma industry and they all bitch about how not only are they being pressed into being junior narcs for Johnny Law, but how if they fail to catch people they will be totally screwed.

      As a software developer I have walked away from multiple opportunities to work on big health care projects because of all the extra HIPAA and other bullshit. There is no way you can do a simple web app without paying through the nose for compliance stuff. And if you fuck up, there is a good possibility that not only do you have a pissed off client, you also might be facing real charges. Yeah, I think I'll just move along and work on other stuff.

      1. Now that I think about it, I wonder how long before the feds start forcing companies that monitor health care stuff like fit bits will start demanding that they search for evidence of health "structuring" (like them saying they are a non smoker, but you can place their fit bit right outside the smokers entrance every couple hours).

        1. That's the amazing thing about it. The government essentially "deputizes" unwilling participants, but gives them none of the powers or leeway that it would give its own agents. So not only are they enslaved, they are *more* prone to being fucked for it than had they never been enslaved. It's like having the sheriff deputize you to go catch some horse thieves, but with no powers of arrest and if you fail to catch them *you* might find yourself on the end of that rope.

          Every day I shake my head and wonder how much people will take before it just becomes too much.

          1. I had a prof who was from commie China who said that they had a saying there: "one bowl of rice".

            Meaning that if the average person was able to get at least one bowl of rice a day they wouldn't revolt. Maybe we should change ours to "One facebook post a day"

          2. Hey, but at least ONE of the parties is aware of this, and fighting the good fight every day, so that we don't end up with a loud mouth billionaire who will speak for them. It's a good thing we're avoiding that.

          3. Even though I played cop, my practice was destroyed for treating chronic pain patients. Forget the facts that I had a graduate school education, surgical residency, (passed boards first time), had extra certification by the American Academy of Pain Management. Knowing more just resulted in the accusations of "You act like you think that you know more than us"! Glad I don't swim with those sharks, being disabled from a spinal cord injury. Sadly, I am unable to get adequate treatment to keep the pain under control. It is sad that those of us willing to help, were driven out of the profession! That happened prior to my injury! God provided an income when I could not get a decent job to support me and my wife!

      2. Isn't that just like government? Make so many damn rules and regulations that it's not even worth it for most private firms to get involved, then fire up the "We need more government because the free-market isn't working" propaganda. Sometimes I wounder if people are really that oblivious, or I'm just missing something.

      3. Over at the Schaffer Drug Library,, a non-collaborationist physician documents the record of how the Harrison Act--preceded by hand-wringing "cocaine negroes" articles in the New York Times--caused physicians to throw up their hands, like so many Frenchmen in the face of National Socialism, as soon as the first indictments threatened their comfy little cartel.

    2. Exactly. The government regularly conscripts businesses and licensed professionals to do its work for them. I applaud Apple for resisting, even if it was just an extreme case.

  4. Addiction isn't the only issue. What of patients who are in actual pain due to their condition? They're harmed by this nonsense. They have to suffer needless pain not because their doctor thinks they shouldn't have the meds, but because some federal LEO who doesn't even fucking know them or care about them thinks they're taking "too much".

    1. Other than committing murder, there's nothing that LEOs love more than making people suffer.

    2. Not to mention the fact that worrying about someone getting addicted to opiates when they are in chronic pain is utter bullshit.

    3. I have said this before, but the government is like flypaper to sadists. It's just the inevitable byproduct of monopoly and those who would seek out having this type of power. Government produces and enables sadism, from denying pain relief to incarcerating/killing non-violent drug users to making working conditions *more* dangerous for prostitutes to...and the list goes on.

      Virtually any government program will end up being sadistic over time.

      1. Preach it, bruthah!

      2. Posilutely, absotively!

    4. Addiction isn't even one of the issues.

      1. Actually it is. Germany held a patent on Heroin and exported the "cure" for opium addiction to China and Africa before the rebellion of 1911 closed China's border to the addictive drug. The interlocking network of mixed-economy parasites--chemical and pharma corporations and Balkan opium producers--were soon at each others throats as the Hague antiopium agreements accumulated signatures toward global restrictions on poisoning primitives. A Bosnian youth provided the pretext and Germany and Austria (huge pharma cartels) went to war to preserve exploitation of addiction the way communists struggle to preserve the income tax as exploitation of altruism.

    5. I have nerve damage in my back which causes pain in my hands. It is usually well-controlled by Lyrica, but I need Norco when it gets really bad. Some days I take none, other days I take maybe two.
      I recently saw my doctor, and since Norco is now C-II and cannot be refilled, and since I don't see him again for three-four months, he wrote a prescription for 90 tablets. My sister the pharmacist was all put out over it, but couldn't give me a reason why, beyond sputtering and saying that it was too many. Too many for what? Of course, she's a manager in the pharmacy authorization department now, so that's probably it.

    6. Been there. Life destroyed by some medical board lawyer and his "State cop"! They "high five-ed" each other when they got another doctor's license revoked. I prayed they would suffer some day because of their hateful attitudes. They will pay...someday? Then, ironically, I am the one in poorly treated chronic pain.

    7. You got it. My doctor cut me off without warning because of the new fed "threats." Two referrals later they want me to go to a pain clinic that requires monthly visits along with tests that would have to come out of my pockets each time. Can't afford it and hoarding the last few I have.

      30 years in chronic pain without any abuse problems should be proof enough, but not with today's witch hunts.

  5. OT: Military budget too low.

  6. The young doctors really buy into this shit too.

    1. They've got student loans to pay and the DEA is holding a gun at their career.

      I don't blame them as much as the government. I hope everyone in the DEA and Congress gets a kneecap shattered, and then is given an Advil and told to walk it off.

      1. I'm sure there are exceptions for the political class worked into these bills.

        1. There always are.

    2. They do? My surgeon spent about half of our time together helping me get around this bullshit, and he was only about 30, pretty young for a full fledged independent surgeon,

      1. My experience is that most, if not all, of the younger doctors I encounter are at the very least obviously afraid of "over-prescribing" opiates, with some even buying into the "try to manage pain in other ways" bullshit (yes, I have heard that verbatim from a younger doctor before). I'm sure that not all do, and if you get one that doesn't that's great, but when I am looking for new doctors I *always* look for older or foreign ones at this point, since they weren't indoctrinated/intimidated by the DEA in medical school.

        1. We had a foreign pcp for a while until he moved away. That guy was great. He'd prescribe most anything you wanted. Our new one is very cautious. He's not a complete stick-in-the-mud, but he isn't willy-nilly like the other one was.

        2. I have had a couple of good under-40 docs, but the young ones are more susceptible to some kind of sick ubermensch mentality that extends beyond the whole pain-treatment debacle. They just don't respect or care about the patients as much and treat you with a smug, snotty attitude. The way medicine is being taught nowadays is a whole different animal. Some universities will even let you enter medical school without any pre-med training at all--you can transfer directly from the humanities department. As God is my witness.

          Anyway, of course the younger docs go along with all this nonsense, because they are scrambling up to the top and don't care how many patients they step on to get there. It's all about the money and status now, not the joy of healing and the fascination of science.

  7. And then you have doctors that are all about that pain and suffering straight up saying that "Zero pain is not the goal of medical treatment" Yeah, just walk that shit off, pussy.

    1. Fuck you Big Tennis Shoe shill!

      I'm going to use the natural age old remedy of rubbing some dirt on it instead. You don't want the sheeple to know about this ancient cure because then you won't be able to sell you fancy shoes.

    2. I once had a doctor refuse to give me antibiotics for a possible case of Lyme's disease (I even brought in the deer tick) because I only had one of the symptoms. I should wait and see if any of the others developed. He was worried about the overprescription of antibiotics.

      I went immediately got into a huge argument with him (involved very loud voices) and when he still refused I went to the front desk and demanded either a new doctor or a refund on my copay because there was no way I was paying a nickel for the quack I just talked to. We settled on my coming back the next day to see a different doc for no copay.

      Some doctors just seem willing to play the odds with your health.

      1. Listen, Jimbo, do you know what would happen if people could just buy their own drugs without a prescription? Chaos, I tell you, chaos.

        1. You think those people are fleeing Mexico for no reason? No! They are fleeing the menace of super bugs caused by too many people being able to buy their own antibiotics whenever they feel like it.

      2. Had similar things happen to me with respiratory infections. You'd think I was asking for meth. I think one doctor even said something along the lines of "people like you make me sick" when I requested antibiotics. Well, yes, I will make you sick if it turns out that what I have is catching and dangerous.

      3. Bureaucrats with stethoscopes.

    3. Boy, the CDC is really good at staying on-message. Shame they're so fucking terrible at everything else.

      1. that's okay cause what they're doing isnt really that important

  8. I react to these reports with great apprehension, because public policy will inevitably impact my profession and me.
    Another smart move would be to "decommission" doctors as agents of law enforcement. Allow doctors to prescribe opioids without fear of prosecution.
    Notice that even at Reason, the answer from the medical Mafia isn't patient freedom, but freedom from all responsibility for the medical Mafia, while they retain their government enabled rent-seeking power over their patients.

    Burst into flames and die rent-seeking scum.

    1. Vote Woodchipper 2016!

  9. I had a coworker with back problems exacerbated by botched surgeries who carried around a bag of pills. The insurance required getting three month's worth at a time by mail, so they were in big jars. He had Oxy-whatever, methadone, diazepam, and a bunch of others. And he needed it. Yeah, I'm sure he was addicted, but you could see the pain in his face when he did simple things. Like walking for example. Haven't seen him in a few years. I hope he can still get his meds.

    1. Ironically this guy was a hardcore drug warrior.

  10. With the passage of the Harrison Narcotics Act in 1914

    And before that, violent criminal drug gangs were completely unknown (because it wasn't a crime), and drug abuse rates were lower. Progress!

    1. Wait, there were still governments before 1914.

  11. Actually, Dr. Singer, during Prohibition a doctor's prescription was required for the purchase of alcohol. My grandfather used to get his rye at the pharmacy. I still have an unopened bottle of James E Pepper bourbon from the twenties marked "for medicinal purposes only."

    1. You better drink it before it goes bad.

  12. Doctors who get their patients addicted to opiates should be fed feet first into woodchippers.

    1. What the hell is with all the "Fargo" references this week?

      1. Did you miss the Feds censoring Reason because of some "high spirited" comments about a Federal Judge and woodchippers?


        Vote Woodchipper 2016!

    2. Good way to make sure a lot of people suffer from chronic pain because the doctors are terrified of statist fucks like you.

    3. Aww, poor little narco. Did the mean doctor keep giving you those pills like you asked him to? Yes, it's definitely all his fault.

    4. Go to hell. You are the reason people I love suffer.

    5. Those of us who take opiates for chronic pain rarely get addicted. About 2% according to studies.

      We don't take it to get high, we take it in order to function, or at least endure. Attitudes like yours cause a lot of suffering of a lot of people for no good reason ... or any reason for that matter. Just your control obsessions.

    6. Yes, every doctor that straps down their patients and force feeds them opiates should be thrown into woodchippers.

      But there's currently a long line for the woodchippers. It's filled with all the thugs who would prevent patients who want opiates from getting them, among many, many others.

      Vote Woodchipper 2016!

  13. Start working at home with Google! It's by-far the best job I've had. Last Wednesday I got a brand new BMW since getting a check for $6474 this - 4 weeks past. I began this 8-months ago and immediately was bringing home at least $77 per hour. I work through this link, go to tech tab for work detail.

  14. The drug war tyranny must end!
    Revolution now!

  15. The very worse addiction is the addition to government, which is much worse than being addicted to heroin and whiskey.

    I have seen progs so addicted to the notion that government will provide a solution to 'global warming' and 'income inequality,' that their eyes are like little black pin holes and their skin texture looks like parchment paper.

  16. Well, at least we know that everything the government does in the name of the war on opiates they are doing for our benefit, and not because of some pork-barrel effort to secure taxpayer monies in order to subsidize an already overfed private indust--oh, wait.

  17. Adam Smith commented that wages tend to decline for older professions. So howcum collaborationist physicians today have the highest incomes of anyone? Might this be a result of the Harrison Act commandeering them into a sort of Vichy Battalion Cartel in coercive mysticism's War on Enjoyable Drugs?

    1. It's no joke when you have your professional license torn from your grasp! Trying to be a good doctor and a good person only ended in misery for me! Then again, it could be a conspiracy to maintain the highest income in your little clique! Conspiracy theories abound! Petty medical politicians!

  18. my Aunty Avery got a fantastic metallic Audi Q5 just by working online with a computer

    1. cool story bro

  19. Nothing in this policy is geared towards protecting innocent citizens who suffer with intractable chronic pain around-the-clock. Some of these patients have been fortunate enough to find a medication, that ALONG WITH OTHER MEASURES, allows them to live a decent life. I am one of these patients whose life has been altered by pain. I've had to accept that there are a lot of things I'll never do now that I'm in a wheelchair. I can deal with that. I've managed to rebuild my life. It's not the life I'd always dreamed about, but it's a good life. I'm incredibly grateful for all that I have. I've worked hard in physical therapy. I pace myself. I don't get to do a lot of the things most 35 year-olds enjoy. That's okay because I've found other things to fill my life.

    Many people say there are other things besides pain pills that people can do to relieve pain. That's absolutely true. When all these other therapies prove inadequate, patients need and deserve access to opioids. Just taking medication isn't enough most people. Pain is an enemy best fought from many angles.

  20. Continued from previous comment:
    So began the worst time of my entire life. I had several doctors who worked very hard to find a new physician to prescribe my medication without success. Week by week I slept less and hurt more. My world had been reduced to my living room. Days became weeks, weeks became months, and all were ruled by pain. Just when it seemed all was lost, my prayers were answered when I received a letter from an out-of-state physician who was willing to accept me as a patient. I've never been so grateful in all my life.

    Having a life again is the most wonderful thing in the world. I'm terrified of losing everything once again and feel that it is only a matter of time before this happens. I'm on a higher dose than most patients due to documented metabolic defects. I didn't cause this. I did not have a choice about developing my genetic neurological condition either. I followed instructions and took my medication as directed. Please don't imprison me within my own body.

    1. You better hope your doctor does not get into trouble for seeing patients that live too far away, or seeing out of state patients. It was one of the things I was accused of when I lost my license.

  21. All medications have risks. The most serious risks associated with opioids include worsening or initiating sleep apnea, risk of overdose and development of Opioid Use Disorder (OUD/addiction). These risks are modifiable though.

    Other treatments with serious risks, many that are essentially non-modifiable (meaning there is little if anything that can be done to reduce risk are prescribed routinely. Opioids are different though. Most of the risks are modifiable and very small IF taken as prescribed. Sleep apnea can be treated with weight loss and CPAP. If hormonal deficiencies develop, treat them. If sedation persists despite dosage adjustments, give a stimulant. Often they augment the effect of the opioid and lower pain level. Some patients are able to even decrease their dose. GI issues generally resolve with time except constipation. If it occurs, treat it early. Dental issues can develop from lots of long term medications, advise them to use something like Biotene. If the patient is at high risk for aberrant behavior, automated medication dispensers prevent the patient from taking medication early. They should be engaged with support service like individual or group therapy, 12 Step groups, and have a support person involved in their treatment. All patients using higher doses, those with sleep apnea, or where there is concern about compliance should have access to naloxone with family and close friends educated regarding its use.

  22. There is risk of gastrointestinal bleeding, liver, and kidney disease resulting from long term use of NSAIDS in addition to concerns of increased cardiac risk. Acetaminophen can also damage the liver either from long term usage in moderate-high doses or with the ingestion of a very large amount in a short period of time. Last week the American Geriatric Society, The AGS, stated that NSAID's were a major threat to those over 75 and they should be prescribed only when absolutely necessary. They feel that opioids are a safer option for most those over 75.

    Risks related to anti-coagulants are worse with much less that can be done to prevent them. Some newer anti-coagulants do not have reversal agents placing patients at high risk of bleeding and possible death. Even those that can be reversed place patient at significant risk for hemorrhage.

    The same applies to TNF inhibitors like Enbrel, which have become popular for treating autoimmune diseases. Doctors generally prescribe them far more readily, even when the patient has factors that elevate risk. Risks include death and disability resulting from development of infection secondary to immunosuppression and certain cancers.

  23. Accutane (isoretinoin) is an effective acne drug that can cause devastating birth defects if a woman becomes pregnant while taking it. Other serious long term risks include Crohn's disease, serious liver damage, night blindness, and onset or worsening of psychiatric symptoms. The FDA requires a REMS - the same program through which long acting opioids and transmucosal fentanyl were required to establish safety plans) that delineates measures physicians must implement to make patients aware of the risks. It ensures women have available contraceptives and male patients are informed regarding the risks of sharing the medication with a woman of child-bearing age. The emotional consequences of acne are significant and prescribing physicians believe the risks are justified in appropriate patients.

    Prescribing in unnecessary doses, longer than needed, or when the patient fails to demonstrate functional benefit isn't smart. Start low, go slow, but adjust the dose adequately and use adjuvant drugs where indicated. Dextramethorphan, found in cough preparations like Robiussin, can be helpful in potentiating the opioid and limiting the development of tolerance. Just as prescribing at higher doses than needed isn't smart, it's equally unwise to allow patients to suffer needlessly. Pain contributes to immobility, weight gain, and diabetes.

  24. Despite serious risks with little that can be done to mitigate the danger, drugs like tumor necrosis factor (TNF) drugs, NSAID's, and even the acne medication isotretinoin are justified as being worth the risk by the medical community. With opioids the risks are largely modifiable, yet the CDC and others don't believe their risk justifies the benefits. It says a tremendous amount about our values as a society that an acne drug with serious long term dangers is an acceptable risk while a drug that relieves pain and suffering, but is addictive in susceptible patients is seen as an unjustified risk by so many. It really seems to be a moral issue about addiction rather than risk-benefit analysis. Many patients who were able to function well and enjoy life on medication are living in a world ruled by pain as I write this.

    1. Very accurate accounting of the situation! I have been going through this for decades now. Having been persecuted for treating chronic pain patients, and now suffering at the hands of the pain Nazis, I have a very poor view of the people who think they have all of the answers. Sadly, they don't even know half of the information. They want to run everything from the basis of their ignorance!

  25. Just went to a doctor yesterday. He took over at the clinic from my older doctor, who retired. He wondered why I drove out so far to come to that clinic, and didn't find a closer doctor. I told him I often found it an issue with doctors not wanting to prescribe one or another of the drugs I take. He said all mine weren't really an issue, but that the feds had made prescribing pain meds a big problem, and people weren't getting what they needed because of it.

  26. So, the logic is: while only a small percentage of opioid users get addicted, we can save them from themselves by denying opioids to everyone. What's next - they throw everyone in jail because that way they are sure that they don't miss any of the small percent that are crooks?

    BTW, exactly what is so terrible about being addicted to drugs. I'm totally addicted to eating and breathing yet that doesn't seem to cause me or anyone else a problem. Even if somebody takes narcotics for non-medicinal reasons, he could take them in a way that does no major harm to himself or others. On the other hand, make the drugs illegal and you're asking for trouble.

    1. some people might make their own lives worse, so we should preemptively make everyone's life worse

  27. "Lives are being lost", so we're going to pass more laws to give law enforcement more excuses to kill people. To protect them. Because that makes perfect sense.

  28. RE: Physicians Face Moral Dilemma In Conscription on War on Drugs
    In the government's new war on opiates, physicians and their patients find themselves caught in the crossfire.

    What's wrong with the government waging war against prescription medicine?
    This should come as no surprise.
    Everybody knows bureaucrats, lawyers, and politicians know how to soothe the pain of someone in misery than any doctor.

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  30. May be preaching to the choir but the book "The Economics of Prohibition" is definitely worth a read.

  31. my roommate's aunt scored 4214 dollars a week on the internet . She has been unemployed for 7 months but previous month her revenue was 14462 bucks just at work on the MacBook for some hours?AJ!20$98/h.php

  32. Start working at home with Google! It's by-far the best job I've had. Last Wednesday I got a brand new BMW since getting a check for $6474 this - 4 weeks past. I began this 8-months ago and immediately was bringing home at least $77 per hour. I work through this link, go to tech tab for work detail. +_+_+_+_+_+_+_+_+

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  34. uptil I saw the bank draft four $8760 , I be certain sister woz actually bringing in money part time from there labtop. . there neighbour had bean doing this 4 only about eighteen months and resently cleard the depts on there home and bourt a top of the range Chrysler ....

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  35. uptil I saw the bank draft four $8760 , I be certain sister woz actually bringing in money part time from there labtop. . there neighbour had bean doing this 4 only about eighteen months and resently cleard the depts on there home and bourt a top of the range Chrysler ....

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  36. And we wonder why heroin use is on the upswing.

  37. This is naive. Physicians actively lobbied for the prescription drug laws that robbed Americans of the right to self-medicate, and they have been the drug gatekeepers ever since. It is false to claim that "a doctor's prescription was never required for people to obtain alcohol." In fact, there was what might have been called medical alcohol during Prohibition, and physicians did write prescriptions for booze.

    It's hard to believe that Thomas Szasz was once a contributing editor of Reason, whose editors seem to have learned none of the lessons he taught.

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