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The Government’s Cure for the Opioid Epidemic May Be Worse Than the Disease

When the cure for the "epidemic" proves worse than the disease, it's time to try something new.

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."

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  • This Machine Chips Fascists||

    Increasing pain and suffering is just one step towards immanentizing the eschaton.

  • $park¥ leftist poser||

    Another clue is that the American Medical Association is actually involved this time.

  • Zeb||

    Nice.

    It's a lucky thing that plane didn't go all the way through the Pentagon on 911.

  • MichaelL||

    The people at AMA were of no help, when I adopted modern pain management techniques along with my general surgery/GP practice in a small town, in about 1993.After reading the information from SUNY. I was even more encouraged. Even after taking a certificate course through the American Academy of Pain Management in Denver. After being drummed out, I became a spinal cord injury patienr. I was one of the walking wounded having exploded L-2 into the spinal canal just below the end of the spinal cord. I have a "post-traumatic cauda equina syndrome". It can be very painful, at times. But, my best experience was about two weeks ago. I was taken , bay ambulance,when I could bately stand! I ended up being placed in the waiting room for six and a half hours of pure agony with renalcolc(pain from a kidney stone. I told the EMT that I thought it could be a stone. My dad and uncle had them! My diagnosis was correct. They said that if I had told them I was a doctor, they would have gotten me right in! How does that make you peons feel?! It angered me to think that "regular people would be allowed to suffer from, the treatable acute pain, of a kidney stone. I just filled out the survey to return to the hospital about their horrendous care. People should not have to suffer! The thing that makes it even more sad is that those who are dying of "opiod overdose" are, as seen in the article, not chronic or acute pain patients.

  • MichaelL||

    It seems that many, of not most, addicts have a mental health basis for their addiction. I don't understand how someone on FOX news said that doctors were being told, by "drug reps" that people would not become addicted to Oxycontin!...(;-P...If any doctor thought that he had to be stupid. For people like this lie about it it makes me feel they think I am that stupid, as well! I am sorry, but I have been aware of addiction since the time I was ten years old. It is unbelievable that any physician would get on TV and say that those of us treating chronic pain thought that there was not a risk of addiction. I was never told this by the "drug reps" seeing me, for the company that makes Oxycontin, either!

    The other part is the difference between a chronic pain patient who is dependent. They are not addicts. They take their medicine, as prescribed, and it improves their lives. Addicts' behavior is harmful to themselves. That is part of the definition of addiction!. There is a big difference. And those studies that claim 8% of the people are addicted come from "addictionologists' studies" They tend to be the ones that most benefit from this opioid propaganda. This is, still, a very informative article that we won't see any MSM, including FOX, get it right! Some studies identify the risk at 0.008%! That's right! Eight out of 100,000! Or none out of a study of 10,000 severe burn patients! Suicide might be preferable to unrelenting pain, 24/7.

  • Cranedoc||

    Boo hoo! A doctor whose made his living as a drug dealer for 45 years won't be able to continue his gig.

    50,000 opioid-related deaths of Americans last year would seem to indicate that there's a problem with this class of drugs. Maybe we should be looking into alternative drugs and treatments instead of making THEM illegal! Kraton tea has been helping addicts get off the smack for decades, but because 15 people died from it over a five year period, the FDA is looking to make it a schedule one drug. Hmm, how's that compare to 50,000 again?

    Vaccines have a higher mortality rate!

    How about marijuana for pain relief?

    And in the non-drug treatment arena: mind-body workshops have had incredible success in reducing and even eliminating chronic pain.

    There are lots of ways to approach this issue. There's no reason we need to be locked into the most destructive and costly of them all.

  • Zeb||

    I don't think that many people's first choice for pain treatment is high dose opioids. But it is what works best for some people.

    I agree that it would be a great thing to find more effective pain treatments that don't come with the dangers and side effects of narcotics. But that doesn't mean it's a good thing to take away treatment that works from people who need it. If junkies choose to kill themselves with drugs, it doesn't make me happy, but it shouldn't affect anyone's medical treatment, or lead to policies that make doctors afraid to prescribe certain things even when they are the most appropriate treatment.

  • JuanQPublic||

    A big problem is that many Americans are under the impression that addiction rates are high among all who are prescribed. That isn't the case. Most who become addicted have existing psychological problems.

  • Zeb||

    And a big lie peddled by prohibitionists and widely believed is that addiction is just a crap shoot and could happen to anyone. Some people are far more prone to addiction than others. And as you say, it is often associated with other psychological problems.

  • Spookk||

    A bigger lie is that "addiction" is by itself destructive, harmful, and bad (as in worse than being in constant agonizing pain, apparently). Most "addicts" to whatever substances are normally-functional people (aside from recognized physical disabilities, of course). The "harm" comes from prohibition, and the associated cops, prosecutors, etc.

    Regardless, people should certainly have the freedom to take whatever medicine, in whatever amounts, they and their doctors deem proper, and if you make a mistake, then it's on you.

  • Echospinner||

    Long term high dose opiate therapy has major downsides. Development of physiological tolerance requires increasing doses over time. Patents no longer respond to normal safe doses. This causes problems because higher doses can depress respiratory drive beyond safe levels in addition to other untoward effects.

    These are serious drugs.

    There is a much longer list of complications.

    Addiction itself is a problem because both for the patient and provider any disruption in availability can result in withdrawal which is a horrible experience.

    Not disagreeing with what you said. Best thing are other treatments and less toxic pathways to treat chronic pain.

    There are many options such as surgery to treat the cause, nerve ablation, morphine pumps which deliver tiny doses directly to the CNS, directed injections of steroids and anesthesia to sources of pain, neurostimulator devices, non narcotic analgesics, physical and psychological therapy aimed at restoring function, other alternatives have been mentioned here like cannabinols all of these are pathways to be explored.

    As you said between patient and physician. Some subset will need long term opiod therapy.

    The politicians only make it worse.

  • MichaelL||

    Only a layman should make the mistake of talking about the never-ending cycle of increased tolerance leading to abuse and addiction It was discovered decades ago, that the tolerance would lead to a stable dose, maintained for long periods of time. But, who cares what scientific studies show? Am I right?

    The respiratory suppression does not occur in the patient chronically raking their pain prescriptions. Those people would rarely be able to overdose because of their high tolerance. Look at cancer patients! I had a friend who tried to help hospice along by giving her mother a big dose of morphine. That dose, which might have killed an opiate naive patient, like me, only made that terminal cancer patient get a good 12 hours of asleep!

  • MichaelL||

    Nerve ablation is useless for anything but a short term remedy for acute and/or chronic pain. Most procedures that attempt this will fail. The only patient that would be appropriate for nerve ablation would be a patient with only a few months to live! Pain pumps and dorsal column stimulators have their risks, as well. Death being the worst risk! (Ever read a story abut overdoses from a pain pump?) I worried when that was the first choice for a "pain doctor" for treating my pain. He had tried nothing else. But, he had the nerve to write Medicare and tel them I had exhausted all forms of treatment!!! I guess that $10,000 payday meant more to him than my high risk of recurrent MRSA, through his procedure. (Once through a MRSA infection was enough, thank you!) Steroids' complications are also numerous! The doses have to be limited to no more than two in six weeks to avoid the complications of physician induced Addison's disease. Sadly, iatrogenic Cushing's disease can also result from doctors who don't consider what they are doing to a patient's physiology, with too many steroids. NSAIDS increase the risk of heart attack, don't they? (Yes, they do!) Those are just some of the frustrations that affect those of us who sought further education of chronic and acute pain management.

  • MichaelL||

    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! This was a poit to point response to "echospinner's" conclusions. Please excuse the numerous typos! I am not a very good proof reader!

  • Echospinner||

    Appreciate the reply.

    Concerning tolerance.

    Tolerance is no doubt one of the downsides of opiate therapy. It can be adjusted for in the use of oral meds for pain treatment. It becomes a bigger problem in the acute setting where a patient on chronic opiod therapy requires surgery or some other intervention.

    This journal article explains the issue.

    ". This means that equianalgesic doses of opioids administered perioperatively will induce more respiratory depression in opioid-tolerant than in opioid-naive patients (note that the dose required to reach this equianalgesic effect will likely be much greater in the opioid-tolerant patient). In other words, contrary to what intuitively would seem to be the case, the opioid-tolerant patient is at an increased risk for respiratory depression when his or her postoperative pain is treated adequately with opioids."

    http://anesthesiology.pubs.asa.....id=2474170

    It is a big challenge because one of the primary reasons for analgesia in the post-op patient is to get them to breathe. This reduces the risk of post operative atalectasis and pneumonia which is a common complication.

    I will try and respond to the other points later.

  • Echospinner||

    OK will try and address some other points.

    "Look at cancer patients!". Palliative care is a separate topic.

    Then you mention some of the other alternatives I talked about. Absolutely, every intervention has limitations, risks and benefits. Individuals respond differently which is why I said it is between patient and physician, there are no magic bulletts and there is a role for opiods. My overall point is that there are tradeoffs there as well.

    "again, you don't seem to know the difference between a pain patient's dependence and addiction."
    Good point dependence would be a better term.

  • MichaelL||

    That is about as much bunk that I have read about "learned men" and the pain managment techniques they are taught/ We, obviously, come from two different schools of tolerance "theories". Many think differently about tolerance and the use of opioids, In practice, tolerance was found to not keep going up without ceasing. Treating those high dose patients takes time and concern from the physician. But, as long as that argument goes on, about the most effective therapy, we chronic pain patients are just going to be guinea pigs given ongoing "experimental" therapy. The, tried and true, method of opiate therapy has effectively treated people for many decades. When taken properly, and not abused they can be safer than NSAID-s or Tylenol. Methadone has its cardiac effects. It is not safe to use on all people. It is a deadly medication for some. So, why not consider using medication when It, honestly, would be the most cost effective therapy available. People should not be forced to suffer at the whims of their practitioners. People and their doctors should be the ones determining which therapy is to be used. The most important aspect of that therapy is to give patients, at least, enough treatment that they should not be thinking that suicide is the only alternative.

  • MichaelL||

    Quality of life, once discussed freely, seems to be, again, being ignored. But, that seems to me to be a lack of compassion towards the patients. Without empathy, suffering is excessive. Effective therapy can be given that does not harm the patient,. It, in fact, makes them feel like waking up every day and participating in life. It allows some to safely continue working. In the end, the best treatment is a truly interdisciplinary pain management program with a team approach. But, insurance companies don't want to pay for the more expensive approach. It is not available to the vast majority of patients in the country. It is just not practical. But it is not the first time that politics has ruined the doctor/patient relationship. I understand you do see the erosion of the doctor/patient relationship. Too many people are being treated by doctors who have no control over their patients, Their hands have been tied by things like opiate guidelines, so poorly designed that they become regulations, instead of just guidelines. The only reason that I mentioned a terminal cancer patient was the idea of any widespread ablative therapy. It is not a practical method of pain management, except in a short period of time. Administrators, and not well trained doctors, are making the treatment decisions. If oncologists had a 95% cure rate, they would be touted as geniuses! And 95% is a conservative estimate, when considering the low rate of addiction in chronic pain patients.

  • Echospinner||

    Once again I appreciate your reply.

    Of course the goal is to cure and treat illness and suffering.

    The government should get out of the way.

    If you know some way to do that in chronic intractable pain, well I do not as a non expert.

    I have nothing else. We are at the limit of medical science and practice. Empathy I have but will not fix anything.

  • LarryA||

    50,000 opioid-related deaths of Americans last year would seem to indicate that there's a problem with this class of drugs.

    Of course there's a problem with the opioid class of drugs. It's the same reason we have overdoses of heroin, meth, and cocaine. The problem is that the drugs are illegal, therefore the source is a black market which has none of the safeguards of a legitimate market.

    One reason to believe this is that the deaths are highly concentrated among people who obtain their opioids on the black market, with very few adverse reactions among people who use them with a prescription.

    I live with someone who is in constant pain. Luckily she has access through the VA, and so faces fewer problems than a non-veteran. Shutting down a medical practice willing to prescribe life-saving pain meds is indeed a tragedy.

  • Elias Fakaname||

    Since I lost both my I siramce, amd my regular internist, it is almost impossible to get ANY prescription pain meds anymore. Even a 20 count of hydrocodone 10's is nigh impossible to acquire at an urgent care. Even though I have diagnosed degenerative disc disease and osteoarthritis in my back. I'm always told to go to my regular doctor that I don't have.

    These gatekeepers and their government masters can all fuck off. Just another reason that all these statist progtards like Tony really do,deserve to be in landfills.

  • MichaelL||

    The great majority of those 50,000 deaths were from addicts abusing heroin (a form of morphine used in some countries for pain control). If the doctors caused it, why have we not seen a dramatic change in the overdose rates since the doctors' prescriptions have been drastically reduced? (Thanks to the ignorant policy makers, politicians and doctors alike!) Sounds like someone is not using their brain to draw conclusions! Any conclusion that Dr Tennant was a drug dealer, pretty much sums up your knowledge of high dose opioid therapy! You sound a little ignorant cranedoc! As far as being the most destructive of all, opiates have been used for over a century with very good results. Do you know that the estimate of deaths due to complications of NSAIDS are a little higher than the opiates?! But, let's not let science get in the way! The sad part is the suffering people go through, in these "mind--body projects, and fail. At that point doctors who don't know what they are doing just refuse to let the patient treat themselves with the only drug that has been proven effective for millions of people! No skin off of their nose if the patient has to suffer!? So much for taking care of the patients first. It makes me want to avoid doctors, altogether!

  • Snowball||

    I wish my 88 year old mother who was filled with cancer in just about every organ in her body including her brain could have had a last resort doctor like Tennant. Perhaps her last few months could have been made a little less painful before she passed away in my back bedroom.

  • JuanQPublic||

    When career politicians like empty suit Chris Christie are heading the "President's Commission on Combating Drug Addiction and the Opioid Crisis", and not doctors, psychologists and experts, that tells us alot already. It tells us that this is a political issue to them, not a health issue.

    Garbage in, garbage out. Like most awful policy in Washington, actual evidence and expertise plays almost no role.

  • D-Pizzle||

    "When career politicians like empty suit Chris Christie..."

    I dunno; his suit looks pretty full to me.

  • Elias Fakaname||

    I'll bet Gov. Tubagoo gets all the pills he asks for.

  • LarryA||

    When the government's cure for the "epidemic" proves worse than the disease, it's time to try something new.

    Good luck selling that idea. When has government ever considered utter failure a criteria for halting a program?

  • Nominalis||

    There's nothing wrong with being addicted to a drug if you have a clean, available and affordable supply which has a standardized dosage and you use it in a responsible manner. Who cares if chronic pain patients are addicted to an opioid as long as they're not suffering. The trigger to confusion for this issue is the 5 decades of Drug War propaganda that's replaced useful knowledge about the drugs that we consume with moral panic and overly cautionary tales. Prohibitions socially acceptable target to hate has always been the "addict" and now medical patients are being swept-up in this 21st century witch-hunt.

  • Plopper||

    I think it's important to understand the difference between addiction and dependence, as well.

  • Kaatje||

    Wow this is a new low in Reason journalism. Dr Tenant already closed shop (not imminent closing) and has moved to Kansas with his wife. I'm so mad about the 'opioid' epidemic when really, there's a raging alcohol epidemic going on, but I'm also annoyed by lazy journalism.

  • Tionico||

    The best thing government can do to reduce/eliminate the problems with illicit drug use, and prescriptioin as well, is to enforce the Constitution, which NOWHERE grants or assigns ANY authority for FedGov to meddle with or restrict (yes, the word "infringe" does come ready to mind here...)anything we put into our mouths. It is simply NOT any concern of FedGov. They've held marijuana to be a Schedule One drug since the mid 1930's, and the stuff meets NEITHER of the requirements to be so listed. So what is the use of Schedule One when it is so egregiously misused?

    Get Fed Gov out of this area, and let states deal with it. Same might make it a capital crme, others no crime. Folks canmove if its that big a deal to them.

  • EWM||

    "Government cure" will always be an oxymoron.

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  • Wally||

    I prefer "enthusiasm" to the newspeak term "epidemic"

  • JFree||

    So how many of the high-dose chronic pain patients are on a govt-paid medical plan or a govt-paid insurance risk pool? Every article I read here seems to imply that not one of them is. That this is exclusively about the govt imposing pain protocols on doctors treating patients who are coming to them from self-insured or employer-self-insured type plans

  • AD-RtR/OS!||

    Here's a cure: Let EVERYONE have as much Oxy as they want Free-Of-Cost on Uncle Sugar.
    When they all OD, problem solved.

  • lamatompila77||

    I would prefer 5 years of Happiness, Than 80 years of Misery.

    You try throwing up Blood every other, Morning Because of Liver Failure,Having your feet twist in on them selves.

    Having over 3 different Unsuccessful Back Surgery's.

    Plus 5 Dental Implants, Due to a Genetic Disease With Trigeminal Neuralgia, PTSD and MS.

    And all except immediately, After the Surgery's of Any Pain Medicine At All.

  • Nikhil1596||

    This article shows the reality of the world. articlenoob

  • lamatompila77||

    According to the DAWN Report the CDC, Just loves Quoiting Over 1.45 million people abused Opioid drugs in 2011.
    But if you read it It say's there were only 420,040 Prescription Opioid drugs abused and Of those 75,693 of them were Methadone, meant to be Prescribed for people already with addiction,


    Meanwhile, Over 501,207 Anti-Anxiety Drugs [Xanax] were abused and they are not Opioid's.


    Another 108,388 Anti-depressants, were abused again, not Opioid's, 76,197 Anti-psychotics were Abused again not, Opioid's, 46,819 Respiratory Medications were abused ie [Blood thinners and Blood pressure medications].


    Then you Have, the, 894,884 cases of abuse against Heroin and Cocaine. That's Just a Little Odd Isn't It?
    And I know that this Study/Report is old but the CDC/FDA/ Jeff Sessions keep quoting it, saying Incorrectly that over 2 million people Overdosed according to the DAWN Report.


    So what we have from the Dawn Report is this, 310,828 abused Prescription Opioid's VS 894,884 Abused Illegal Drugs, like Heroin/Cocaine


    So we go back to this


    "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.


    Why are they Not going after the Drug Dealers And the Cartels, Instead of People in Severe, Chronic Pain, or End Of Life Care.

  • allwishes4u||

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