Politicians and journalists often tell a story about greedy pharmaceutical companies that turned doctors into dealers and patients into addicts. And now, we're told, tens of thousands of Americans are dying of overdoses every year because of government inaction.
If this is truly an epidemic, the diagnosis is wrong in a few major ways. And the cure prescribed by the government is making the disease worse.
Pain and Suffering
Dr. Forest Tennant is one of the last doctors in America willing to treat pain patients using high doses of opioid painkillers. He operates out of a strip mall in West Covina, California. And he's contacted by patients from all over the country on a daily basis, pleading with him to treat them because nobody else will.
But in a matter of months, thanks in part to increased pressure in the government's war on opioids, he may be closing his clinic's doors, which have been open since 1975.
When Reason did a story on Tennant's clinic in 2017, his patients spoke of how government restrictions on opioid use were causing legitimate pain patients to suffer needlessly. Four months after we ran that story, the DEA raided Tennant's clinic and home. The search warrant accused him of overprescribing medication and accepting payoffs from the pharmaceutical company INSYS. Tennant has earned speaking fees from the company as recently as 2015, which he says is standard practice. And his nonprofit clinic regularly operates at a loss, according to financial statements submitted to the Department of Justice.
"I think the government is trying to kill me and every one of [Tennant's] patients," said Gary Snook, a resident of Montana, when asked about the raid on Tennant's clinic. Snook, who suffers from chronic pain resulting from back surgery complications, turned to Tennant when he couldn't find adequate pain treatment from a local physician.
"We have no place to run," says Snook.
Last year, the Centers for Disease Control recommended new opioid prescription guidelines, with a maximum dosage of 90 morphine-milligram equivalents (MME) a day. Although the guidelines were supposed to be voluntary, Tennant says most physicians have begun to treat them as mandatory. Several states have adopted legislation that mirrors the federal recommendations.
"I do not know of physicians who will be willing to prescribe high-dose opioids anymore," says Tennant.
This situation has put a target on the back of doctors who don't follow the guidelines, and Tennant says the pressure that the guidelines have put on him are a major reason that he's decided to wind down his practice and focus on tapering his patients down below 90 MME so that they can find other doctors to treat them once he retires.
But he maintains that some patients exhibit genetic variations that require them to take unusually high doses of opioids to achieve pain relief.
"I don't know how those people are going to get down to 90," says Tennant. "There has been propaganda—and it's pure propaganda—that you can just stop opioids. No need to taper them. Just stop. And we're going to have some patients commit suicide."
Prohibition, Then and Now
Government officials like Attorney General Jeff Sessions and former New Jersey governor Chris Christie, who heads the President's Commission on Combating Drug Addiction and the Opioid Crisis, have repeatedly blamed the problem on doctors overprescribing opioids to their patients and turning them into addicts.
"It's not starting on our street corners. It's starting in our doctors' offices and hospitals," Christie told CNN's Jake Tapper in July 2017.
But the story isn't quite so straightforward. Several studies, including a recent one out of Harvard, pegs opioid abuse among postsurgical patients at less than one percent. Estimates about abuse among chronic pain patients vary, with the high end being a little less than eight percent.
"Most policy makers have bought into this idea that we doctors prescribe opioids to our patients, who then rapidly become drug addicts," says Jeffrey Singer, a Phoenix-based general surgeon and policy analyst (and a donor to Reason Foundation, the nonprofit that publishes this website). "All of the evidence suggests that this is not the case."