Tuesday, July 22, 2014





Jacob Sullum: Drug control versus pain control


August 24. 2013 8:47PM
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Last week, unveiling a plan to curtail “diversion” of opioid painkillers, Obama administration officials said they aim to “strike a balance between our desire to minimize abuse of prescription drugs and the need to ensure access for their legitimate use.” This balance will never be achieved because the two goals are fundamentally irreconcilable.Since pain cannot be verified objectively, there is only so much a conscientious doctor can do to make sure a patient is not a malingerer, an addict or a drug dealer. At a certain point, he has to choose between trusting his patients and helping the government enforce its arbitrary dictates regarding psychoactive chemicals. If he sides with his patients, he risks his license, his livelihood and his liberty. If he sides with the government, it is inevitable that some patients will suffer needlessly.Doctors are less inclined to prescribe opioids, even to legitimate patients in horrible pain, when they worry that regulators, police and federal drug agents are looking over their shoulders, ready to second-guess every decision and transform honest mistakes or medical disagreements into felonies. Every additional layer of scrutiny only compounds the drug war's chilling effect on pain treatment.That is one of the problems with the computerized prescription drug monitoring programs (PDMPs) that the Obama administration wants every state to establish. The benefits of such programs, which 35 states have implemented so far, are questionable. A recent study by researchers at the U.S. Centers for Disease Control and Prevention found that “PDMP states did not do any better than non-PDMP states in controlling the rise in drug overdose mortality from 1999 to 2005.”To the extent that PDMPs do succeed in changing doctors' prescribing practices, the impact won't be limited to nonmedical users. Data from the National Survey on Drug Use and Health indicate that 70 percent of nonmedical users get painkillers from friends or relatives with prescriptions. Cutting off these sources through aggressive monitoring is bound to hurt many legitimate patients.The same thing is true of the Obama administration's proposed requirement that doctors be barred from prescribing narcotic painkillers until they receive “training on the importance of appropriate prescribing and dispensing of opioids to prevent adverse effects, diversion and addiction.” First, the training mandate (which would require new legislation) would reduce legitimate patients' access to painkillers by reducing the number of physicians authorized to prescribe them. Second, the focus of the training would tend to make doctors even more suspicious of patients seeking pain treatment.To justify a crackdown that will be effective only if it hurts people in pain, the Office of National Drug Control Policy says we are experiencing a “prescription drug abuse crisis” that amounts to an “epidemic.”Although there is little evidence of such an epidemic in the federal government's own survey data, the number of fatal overdoses involving opioid analgesics nearly quadrupled between 1999 and 2007. Meanwhile, the amount of opioids prescribed per person has increased by an even larger percentage, meaning the risk of overdose is smaller today than it was a decade ago.These overdose deaths mainly result from careless decisions by nonmedical users who either take too much or mix narcotic painkillers with other depressants. All the talk of an “epidemic,” which brings to mind a deadly microbe that infects people who have no choice in the matter, tends to conceal this reality. The New York Times says OxyContin “hurtled through” an Ohio town, as if it were a tornado indiscriminately wreaking havoc instead of a drug deliberately taken by people who like its psychoactive effects.By contrast, people who suffer from severe chronic pain as a result of car crashes, botched surgeries or degenerative conditions do not choose to be in that situation. It's bad enough that they are forced to beg government-appointed gatekeepers for relief. They should not be punished further because of other people's reckless choices.Jacob Sullum is a senior editor at Reason magazine.





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