Martha Coakley, the district attorney for Middlesex County, Mass., responds to my letter to the editor of the Boston Globe:

IN A Feb. 12 letter (”Accidental addiction can be overstated”) Radley Balko of the Cato Institute took issue with my comment that we have a problem with addiction to prescription drugs in Massachusetts. In fact, the argument he makes — that the medical literature does not support my assertion — actually highlights part of the problem. The failure to recognize the extent to which the use of prescription medication represents a risk of addiction may well explain the phenomenon that we see on the streets every day.

The writer refers to research indicating that few, if any, users of prescription pain drugs are addicted. That research, however, refers to cancer patients, and does not appear to take into account, for example, those who suffer from injuries due to car accidents nor those with chronic back problems.

I do not pretend to be an expert in medical issues. However, in Middlesex police officers we work with and our prosecutors see a growing problem — one that I have specifically labeled a public health problem, not just a law-enforcement problem. There are too many people of all ages, but especially younger people, who abuse prescription drugs. Sometimes the drugs are prescribed for them by physicians. Sometimes they have been prescribed for a family member or purchased on the street. Sometimes these people overdose; sometimes it is fatal.

My experience says that it would be helpful, indeed critical, for a more open-minded approach than that suggested by Mr. Balko: Law enforcement should be educated by doctors, but doctors and pharmacists cannot ignore what we are seeing on the street. Long-term and short-term pain management should be between doctor and patient, but doctors must realize their level of responsibility involved in that management.

Note the typical arrogance we’ve seen from prosecutors on this issue. Never mind the research. She is certain there’s a problem. She cites no statistical evidence. Just her assertions. Trust me. I’m a prosecutor.

Well, no.

First, she’s wrong. I cited one study in my letter because, frankly, in a letter I didn’t have the space to cite the littany of medical research on this issue. Mrs. Coakley should know that medical research shows that so-called accidental addiction is nearly nonexistant in all patients taking high-dose opiate therapy under the watch of a physician, not just a cancer patient. I don’t know why she’d think that, on average, a chronic pain patient would react any differently than a cancer patient.

Second, it’s odd that a prosecutor who refuses to even read the medical literature, and who insists that, in any case, the peer-reviewed literature is wrong because of her own limited experience in Middlesex County would ask that I be more open-minded.

Third, Ron Libby effectively debunked the myth that there’s an epidemic of people overdosing on prescription OxyContin in his paper on the topic for Cato.

Fourth, the idea that there’s massive prescription drug abuse in this country is, like most statistics on drug use, massively inflated. College kids who are popping Adderall to help study for a test are included. If you’re spouse gives you a Percocet he/she was prescribed because you have a migraine, that’s an incidence of abuse. Likewise with a Valium. Buying prescription drugs over the Internet counts as an incidence of abuse.

Fifth, even if there is prescription drug abuse going on, you don’t punish the patients who need those drugs and the doctors who prescribe them just because some people happen to be abusing them. Having law enforcement looking over the shoulders of doctors does exactly that. If real addicts are using Oxy in place of heroin, the fault lies with the addicts, not with Oxy, not with the doctors who prescribe it in good faith, and certainly not with the legitimate patients who need it. Make Oxy difficult to obtain, and the addicts will switch to something else, perhaps go back to black market drugs. Pain patients don’t have that option.

Finally, it’s thinking like that on display in Coakley’s letter that’s contributing to the epidemic undertreatment of pain. She confuses addiction with physical dependence, and concludes that in her nonmedical, but carries-the-force-of-law opinioin, the two are the same, and should be eradicated by cops and prosecutors.

It’s this kind of attitude that leads to “opiaphobia,” and the wholesale dismissal of a class of drugs that could bring millions of people relief. It’s also this kind of thinking that gets people like Richardy Paey and Bernard Rottschaefer railroaded into prison.

Libby’s paper outlines a particularly heartbreaking example of opiophobia from Time magazine a few years ago: A doctor tells the reporter about a young boy who’s in the final stages of terminal cancer. He’s in agonizing pain. His father refuses to let the physician give the kid the morphine that would prevent him from spending his last days in pain. Why? He told the doctor, “I don’t want my son to die a drug addict.”

This entry was posted on Wednesday, February 22nd, 2006 at 7:51 am by Radley Balko and is filed under Pain Treatment, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.