Another largely sympathetic editorial with another unfortunate mistatement of fact:

Martha Coakley, district attorney for Middlesex County, said she does not think that overzealous prosecution of prescription drug abuse is a problem in this state. Speaking of her own office, she said, ”We would stop short of micro-managing” pain treatment. But she said there is a problem of prescription drug users becoming addicted to substances like OxyContin. Coakley is right that prescription drug abuse is a problem, just as the use of methamphetamines, heroin, and cocaine is. But patients will suffer needlessly if prosecutors and the DEA do not fine- tune their investigations of suspected prescription abuse.

On the issue of overzealous prosecution not being an issue in the Bay State, I’ve spoken with at least one doctor in Massachusetts who’d beg to differ.

But that’s not my objection to the passage. My objection is to the notion that “there is a problem of prescription drug users becoming addicted to substances like OxyContin.” It’s a cannard. From a 1997 cover story in U.S. News and World Report (sorry, no link):

What is lacking is not the way to treat pain effectively but the will to do it. For a quarter of a century, pain specialists have been warning with increasing stridency that pain is undertreated in America. But a wide array of social forces continue to thwart efforts to improve treatment. Narcotics are the most powerful painkillers available, but doctors are afraid to prescribe them out of fear they will be prosecuted by overzealous law enforcers, or that they will turn their patients into addicts . . . “We are pharmacological Calvinists,” says Dr. Steven Hyman, director of the National Institute of Mental Health.

The authors go on to state:

But at the heart of the debate is confusion about what constitutes addiction and what is simply physical dependence.

Most people who take morphine for more than a few days become physically dependent, suffering temporary withdrawal symptoms–nausea, muscle cramps, chills–if they stop taking it abruptly, without tapering the dose. But few exhibit the classic signs of addiction: a compulsive craving for the drug’s euphoric or calming effects, and continued abuse of the drug even when to do so is obviously self-destructive. In three studies involving nearly 25,000 cancer patients, [researcher Russell] Portenoy found that only even became addicted to the narcotics they were taking . . . “If we called this drug by another name, if morphine didn’t have a stigma, we wouldn’t be fighting about it,” says [researcher Kathleen] Foley.

If you check the footnotes to Ron Libby’s Cato paper on the painkiller wars, you’ll find several other studies negating the link between opiate painkillers and addiction, including:

1. J. Porter and H. Jick, “Addiction Rare in Patients Treated with Narcotics,” New England Journal of Medicine 302, no. 2 (1980): p. 123.

2. J. L. Medina, S. Diamond, “Drug Dependency in Patients with Chronic Headaches,” Headache 17, no. 1 (1977): 12-14. This survey of patients treated at a large headache center during 11 months could only identify three problem cases (two codeine abusers and one propoxyphene abuser) among the 2,369 patients who had access to opioid analgesics.

3. D. E. Moulin et al., “Randomized Trial of Oral Morphine for Chronic Noncancer Pain,” Lancet 347 (1996): 143-47. This study used a cross-over design to compare the opioid against a placebo (benztropine) to ensure blinding of the therapy. The study evaluated a broad range of outcomes related to subjective effects and function. The results demonstrated a significant reduction in pain during morphine therapy, without change in physical or psychological functioning, and without evidence of psychological dependence or aberrant drug-related behavior.

Now, I don’t expect a Massachusetts D.A. to be up on all the latest medical literature (or even three-decades-old medical literature, for that matter). But the fact that this particular D.A., like many just like her, isn’t familiar with it is a pretty compelling argument for keeping law enforcement officials out of the business of dictating medical treatment, wouldn’t you say?

This entry was posted on Monday, February 6th, 2006 at 4:33 pm by Radley Balko and is filed under Pain Treatment. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.