Reason Podcast

The Opioid Crisis Isn't What You Think It Is—and It Can't Be Stopped by More Drug War: Podcast

Reason's Jacob Sullum and Zach Weissmueller talk about the human toll on patients and their doctors.

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Across the country, overdoses and crimes attributed to drugs such as hydrocodone, oxycodone, codeine, and fentanyl are up. Heroin, once an exotic and expensive drug, is now widely available and reportedly as cheap as $5 a pop. Politicians, law enforcement, and the medical community are scrambling to respond. Media coverage abounds.

What is the reality of the opioid "epidemic," what are its causes, and what are its effects on chronic pain patients, whose demand for prescription drugs is often (and incorrectly) blamed for causing the problem? In this Reason Podcast, I talk with Reason's Zach Weissmueller, whose latest documentary follows a pain doctor who is retiring rather than put up with increasing government hassles and surveillance, and Jacob Sullum, a finalist for a National Magazine Award for his article "No Relief in Sight: Torture, despair, agony, and death are the symptoms of 'opiophobia,' a well-documented medical syndrome fed by fear, superstition, and the war on drugs. Doctors suffer the syndrome. Patients suffer the consequences." That story was published way back in 1997, a striking indication of just how long—and how ineffective—the war on pain drugs has been.

"Contrary to the impression left by most press coverage of the issue, opioid-related deaths do not usually involve drug-naive patients who accidentally get hooked while being treated for pain. Instead, they usually involve people with histories of substance abuse and psychological problems who use multiple drugs, not just opioids," Sullum writes in a cover story for the April 2018 Reason. "Treating pain medication as a disease vector, the government has restricted access to it by monitoring prescriptions, investigating doctors, and imposing new limits on how much can be prescribed, for how long, and under what circumstances. That approach hurts pain patients by depriving them of the analgesics they need to make their lives livable, and it hurts nonmedical users by driving them into a black market where the drugs are deadlier."

Sullum appears in Weissmueller's documentary about Dr. Forest Tennant, who is shutting down his five-decade-long practice in Southern California after being raided last fall by the Drug Enforcement Administration. Sullum and Weissmueller discuss misconceptions about opioid abuse, and they talk about how to help both abusers and patients in ways that won't cause needless suffering and pain.

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You can watch Zach Weissmueller's documentary here:

Audio production by Ian Keyser.

Photo Credit: Erik McGregor/Pacific Press/Newscom

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  1. Drug warriors are the Nazis we love.

    There’s nothing more stupid than the regulation of drugs in this country. You shouldn’t need damn prescription to get drugs, must less throwing the book a doctors for essentially giving advice.

  2. Stewart Baker over there on Volokh would beg to differ – us silly-ass libertarians are responsible for the opioid crisis because we favor allowing people to use drugs if they want to which encourages more drug use and since the drugs aren’t legal it encourages Chinese drug manufacturers to produce fentanyl, which is what the opioid crisis is all about. The reasonable response to this is cracking down on opioid distribution of any kind, the same way cracking down on the possession of assault weapons will deter people from killing each other with pistols or knives or sticks and rocks. It’s apparently much easier to change human nature than it is to change your response to human nature.

    1. skids; there are about 400 million guns in this country. try that crack down called your girlfriend, eh? You need schooling, on your own. You believe what you want, doesn’t make it true. That “crack down” ? absurd, unless done as love, then such is delightful, no? May you never get a disease that is painfully crippling (as have millions), and all those accidents you had, from bike, to car, to falling out of trees, (hundreds of millions) will show as you grow older. The human body, obviously, has not had the time to adapt to the machines of the industrial age; our brave new world. Even the speed of a bicycle is enough to kill you, never mind inflict damage; damage that will show up later in life. Live long and prosper. May you never need pain relief, and the only good crack down is in her bluejeans if I may use a little adult humor here..peace..#:-)

  3. Of course 435 federal legislators know more about your medical treatment than any doctor who has actually examined you. How can this actually be an issue? It’s not like individuals respond differently to medications, and need different levels of medications for different periods of time. If that was true, then medications would come in different dosages, right?

    Something about equal rights; a woman can actually kill a baby because it is her ‘right to choose’. but neither men nor women can ‘choose’ any other medical treatment on their own.
    Makes no sense to me.

    1. Your right to privacy in medicine only counts for your uterus.

    2. People would think differently if abortions were enjoyable, hence attractive, to a segment of the popul’n.

      The legislators & the people they represent think most docs are honest, but that unless you keep them on a short leash, some will be corrupt. It’s not too different from the attitude people have about politicians.

      1. The DEA has full and complete control of the national prescribing of legal opioid medication. The PDMP has just hooked up nationally. That is the computer system that keeps track of each and every prescription in the country. Some states had it, and now it is national. The government has set “recommendations” for dosage that doctors prescribe beyond at their peril. Doctors, pharmacists, nurses; all have been threatened by those who hold their license, and pharmacists have been told they may choose to not fill a prescription if they “don’t like” a patient, and to report any doctor they suspect. Achtung, achtung.
        And they don’t have a clue, other than complete control of legal pain medication, with the newly online PDMP. And heroin dealers all, are smiling. At you

    3. Killing babies is illegal. You seem to me like the kind of person who thinks that women shouldn’t work.

      1. Nope, I think women make great baby killers…minimum wage of course…

      2. And remember, everything the Nazis did, was completely legal…

  4. Make heroin free to all. Let Natural Selection work it’s wonders.

    1. Why stop at heroin?

      Just imagine if we legalized all drugs and spent all the War on Drugs funding on education and rehabilitation. It would be a much more humane way of wasting billions of dollars each year.

      (Or we could use that funding to pay down part of the national debt, as if that would ever happen.)

      1. How about we stoo funding the drug war…period? No financing for rehab. You want to kill yourself? Feel free.

  5. If addicts are determined to die, let them. I don’t understand this obsession with government trying to save addicts. Stop it.

    1. Agreed.

    2. That lacks compassion for those who get themselves into an addiction by abusing drugs! You know, it is happening to everybody’s son, daughter, brother, sister… Heroin, in its pure form is diacetyl-morphine. Fentanyl just makes it deadlier. It is partly the problem with illegal drugs produced in clandestine laboratories. The impurities kill! Lack of dose control adds to the deaths as well. Personal responsibility seems less important than government control!

      1. “The impurities kill! ”

        Lol. No.

        It’s the heroin that kills.

        Or the fentanyl
        Or the morphine
        Or the oxycodone
        Or the hydromorphone

        Take too much of any one and you will die. Play mix and match and your chances of dying only go up.

        The impurities give you scarred up veins, and infections. Sometimes liver damage, sometimes kidney damage. Taken orally most of the “impurites” do nothing.

  6. What caused narcotics to decline in popularity for so many yrs.? What we’re seeing now is a return to their previous popularity.

    1. BUUUUSSSSHHHH….no wait…TRUUUUMMMPPP!!!

    2. Robert; I believe you would love the answers of “Chasing the Scream”, by Johann Hari. Almost rage reducing, so much is cleared up by Hari’s homework. He went to Pennsylvania, where Harry Anslinger’s papers are stored, and found out. A few good books, written and read clearly, can open a whole wide world of understanding; who, what, when, why, and where? I am recently off of a 21 year medical course of what is considered high dose opioid (18 yrs. 1,010 mgs. of morphine, then 3 years of Fentanyl, 100 mics/hr. 1,010 mgs. is NOT a mistype; and I left morphine on my own,( and yes, such nearly killed me…yet here I stand), because I cannot legally reach efficaciousness within government practicing medicine, and I am not going to the street. Street legal I am; and know,;,;,; I do…#:-) To try a little humor, you would need a wheelchair just to read my MRI. And yes, it hurts. Sister Morphine, and her sisters I know well, and from afar, far away now. Don’t go see her in any serious relationship unless you have the wherewithal to stay. I don’t recommend such pain relief unless, and until you have tried any other way to relieve that pain you and millions of Americans have. Or will have..peace

  7. Thanks for these articles. Sadly, those who need to listen will not! Having been on both sides of the “problem”. Recently, I suffered for six hours with renal colic, from a kidney stone. They thought leaving me sitting in the waiting room some how was good for me!? If I had told them I was a doctor, they said I would have been seen sooner…(;-P…. So, what the heck is happening to all the rest of you peons?!

    I also suffer from a peripheral neuropathy as the result of a broken back, and a thing called cauda equina syndrome. That is chronic pain, if left untreated, might cause one to contemplate suicide!. I barely get enough tramadol to make life worth living. If I limit my activities, I get by. But, that inactivity will likely shorten my life, too! And it gives me a real crappy “quality of life”, too!

  8. Bluntly, I do not care if junkies die.

    If I have to pay for their treatment, then I want strict limits on what those asshats can do.

    Kill yourself on YOUR dime, not on mine.

    That is what “libertarians” constantly ignore. WE have to pay for their behavior. Therefore, like it or not, we have ample rights to say “Nah son, you cannot do that”

    If the government didn’t give one red penny to save a junkie, then there’d be no reason to care.

    So, advocate ending ALL government support to take care of overdosing cases and we can talk.

    1. d; any idea how much a war costs; especially when there is no result, none. Other than, heroin has only gotten more potent, more plentiful, and less expensive. And now, it comes from the Greater Middle East, as well. No wall in the world will even slow down the most widely used drug in history, other than another plant, cannabis…and for “insight” we are reduced to watching my favorite new movie “Sicario”; the first one. Happy such hard boys are on our side, yes? South of here is bloody chaotic slaughter, and no one is talking about the cause of the immigration chaos of people fleeing, in exodus. The drug war

    2. d; “The government” (can you tell me who that is?) loves it when you talk into your own echoing wind tunnel; all of us, no? Who is we, and what are you angry at. The prez just gave hundreds of billions of your money to his wealthy friends, and handed you a dime, with promises of a nickel. And who is thanking him? You having a good time?..con paz, con paz, amigo..your alarm clock should be going off soon, no?..peace

    3. You have no right, son, to say anything other than what is in the BIll of Rights, and Constitution to me, son. Nah, you cannot do that. Support to take care of overdosing..??..when you figure out what you are talking about, let’s chat. Set your alarm clock; son.

  9. Even most physicians don’t have enough education to be judging the other physicians that would use high dose opioids! I am sure that patients would prefer their doctors to be ignorant!? And, again, you don’t seem to know the difference between a pain patient’s dependence and addiction. But, why would a layman know? Most doctors don’t have a damned clue!

    1. This is a misplaced comment! Should have been elsewhere, in another article. Sorry!

  10. ” Heroin, once an exotic and expensive drug…”

    Sweet Jesus, where do you guys come from???

    1. The George Will style of argumentation is not something to emulate.

    2. Heroin at the turn of the century, could be bought for a dollar a pure ounce, over the counter, at department stores. It was called “calming powder”. Historical reality is fascinating.

  11. The more of these freaks who die of ODs the better. Don’t help them at all.

    1. Who will drink to that; alcohol, another drug of potentially great harm; oh, wait, it IS A DRUG of great harm; and of choice for well, you know who you are, no?..#:-)

    2. DV; such love you have; your kids are GONNA LOVE YOU. “These freaks”, you speak as if they are in your head; oh, yeah, no?. Who are they, and what is reality; you know, consensus reality, the social construct, and how does it work? Nothing personal

  12. we’ve had the WAR ON DRUGS for some time now…I think DRUGS won…

  13. Opiophobia, fear is what is used to stop legal opioids, and insure a boost in heroin sales, which is, in fact, what has happened. Pharmacists have been told to report any doctor they believe has less medical skills than they, the pharmacists do. Pill mills, and greedy docs are gone. The “government” has control of the situation. The PDMP has gone national, and “they” know. Period. Doctors, pharmacists and nurses over the entire country, when “the opioid crisis” came to the forefront about 3 years ago, were all threatened (the DEA has your doctor’s license), and told to report each other (achtung, no?); and the only people smiling are heroin dealers. Afghanistan’s GDP is opioid base, and the Afghanis have learned to make heroin. Up to 90% of Afghanistan’s GDP is opioid based. Where are we? We can win the drug war; it’s easy. Legally allow and control it. Who does not want pain and suffering the world over to stop? And it all began with one old queen deamon, Harry Anslinger (he was responsible for the murder of Billie Holiday, by the way). Anslinger, whose psychic progeny include Nixon and Arpaio. The drug war has nothing to do with drugs; “they” laugh at you while you debate that it is. Welcome to “the opioid crisis.”

  14. DV; a little homework, and open eyes reveals how many, from our top military, to captains of business, to the streets, use opioids. Pray you never feel the damage from disease, or that bicycle wreck you had when you were 8. Never mind that car wreck boo boo. Live long and prosper.

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