For the second time in as many months, Reuters has produced a refreshingly balanced, well-reported article on a hot issue that has sent many of its competitors into hysterics. This time, it’s the prescription painkiller panic.
The long article lays out the usual figures about painkiller addiction and overdose deaths, but then delves into the effects the resulting DEA crackdowns are having on doctors, patients, and pharmacists.
Pamela Storozuk, a petite 59-year-old, spent most of her career as a sales representative, dragging heavy suitcases filled with presentation materials. When her husband developed prostate cancer, she cared for him, often helping to lift him out of the bath or into bed.
Eventually, the strain on her back caught up with her. Today she has five herniated discs and relies on painkillers to function.
Over the past six months, however, the Fort Lauderdale, Florida, resident has found it increasingly difficult to get her medications. Her regular pharmacy is often out of stock, and others refuse to dispense painkillers to new patients.
“They look at you like you’re an addict, a lowlife,” she said.
Storozuk is one of thousands of Americans caught up in the government’s latest front in the war on drugs: prescription painkillers. From 1999 to 2009, the number of deaths from narcotic pain pills nearly quadrupled to 15,597, more than those from heroin and cocaine combined, according to the latest figures from the U.S. Centers for Disease Control and Prevention.
In response, the U.S. Drug Enforcement Administration has beefed up its efforts to block the diversion of prescription drugs to the black market, using many of the techniques it employs to combat illegal drug use: wire taps, undercover operations and informants.
Such efforts have helped it dismantle hundreds of “pill mills” – sham pain clinics that write thousands of prescriptions with few questions asked – as well as dozens of rogue Internet pharmacies.
Now the agency is using the same tactics to prosecute the legitimate pharmaceutical supply chain, which is required to maintain certain record-keeping and security protocols to prevent drug diversion.
Which is another way of saying that pharmacists can be held civilly and criminally liable if they don’t adequate police their own customers. They’ve basically been both deputized and told they can go to prison if they’re insufficiently skeptical about the people they’re supposed to be serving. (The article also points out that, as it’s been doing for 10 years, the DEA refuses to provide any clear-cut guidelines for any of the professionals involved in painkiller distribution. The fuzziness of course takes away the potential defense that the doctor or pharmacist followed DEA guidelines.)
“The techniques that law enforcement uses to combat drug traffickers, whether they’re Colombian organizations or Mexican cartels or Afghan drug lords, those techniques are very, very essential in combating prescription drug abuse,” DEA Administrator Michele Leonhart said in an interview.
But critics say applying the same strategy to the legitimate supply chain as to Colombian drug lords is ineffective and is also causing supply shortages that hurt pain patients.
“Going after a pharmaceutical manufacturer is not like going after the Medellin cartel,” said Adam Fein, president of Pembroke Consulting, which advises pharmaceutical manufacturers. “I don’t believe it is appropriate for the DEA to shrink the supply of prescription drugs, because it has unanticipated effects that have nothing to do with the problem.”
Effects like making life a living hell for pain patients—and effects that are entirely predictable, no matter what the drug czar says. The DEA is now quite literally treating doctors and pharmacists like potential drug dealers.
The agency has expanded its use of tactical diversion squads, which combine special agents, diversion investigators and local law enforcement officers to track down and prosecute prescription drug dealers.
Forcing the two sides to come together was not easy at first, Leonhart said, since special agents initially were reluctant to work on “pill cases.”
But the effort has shown some results. Asset seizures on the diversion side rose to $118 million in 2011 from about $82 million in 2009, Leonhart said.
That’s a telling metric, isn’t it? The same drug warriors who tell us prescription overdoses are skyrocketing claim, at the same time, that their decade-long anti-diversion efforts are working because . . . the government has been more successful at taking money and property away from people. Let’s not forget that in a civil asset forfeiture case, the government needn’t even charge you to take your stuff, much less convict you.
What’s really remarkable is that the DEA is admitting that it’s putting a squeeze on the overall availability of prescription painkillers, which of course will affect legitimate patients as much as recreational users. Meanwhile, the drug czar is giving us the old “Nothing to see here,” brushing off the notion that real pain patients are having difficulty filling their prescriptions. (The 400 or so desperate pain patients who have emailed me over the last few months would disagree.)
Still, sending in tactical diversion squads to break up pill mills does not address the leaks occurring from medicine cabinets at home or the drugs passed along from friends and family. That is one reason the DEA is attempting to squeeze supplies at the wholesale level.
“Going after Cardinal has sent shivers up the distributor grapevine,” said John Coleman, a former DEA chief of operations. “Close a CVS pharmacy in Florida, and I guarantee every pharmacy within 500 miles will be checking their records.
“You don’t have to hit a horse with a whip,” he said. “You just have to show it to them once in a while.”
Charming. Czar Kerlikowske has also assured us that legitimate doctors and pharmacists aren’t worried. Again, this is bullshit.
Pharmacists confirm that they are indeed fearful. Some are reluctant to take new painkiller customers. Others will only accept patients within a certain geographic area or refuse to accept cash.
“We turn away five or six people a day,” said Steven Nelson, owner of the Okeechobee Discount Drugs store in Okeechobee, Florida, and chairman of governmental affairs for the Florida Pharmacy Association.
Even large chains are leery. Walgreen spokesman Michael Polzin said that after looking into everything going on in Florida, “we’ve decided not to comment on our operations there at this time.” . . .
Physicians are equally nervous. Many have stepped up patient monitoring, according to Storozuk’s physician, Dr. Martin Hale. That means more urine tests, more documentation, and more frequent “pill count” checks, where patients must go to the doctor’s office with their pill bottle to prove they have not sold or misused their medication.
“Every hour of the day I have concerns I’ll be audited, that my ability to take care of my patients and my family can be taken away, and I’m as legitimate as you can get,” said Hale, who has a private orthopedic practice a few miles from Fort Lauderdale and is an assistant professor at Nova Southeastern University. “You’re constantly watching over your shoulder, and it takes a toll.” . . .
John Burke, president of the nonprofit National Association of Drug Diversion Investigators, says the DEA behaves as though those it monitors are the enemy.
“The mindset is, these are folks we have to keep at arm’s length,” said Burke, whose organization tries to foster communication between law enforcement, regulators and industry.
As long as you have a law enforcement agency bringing a law enforcement mindset to what ought to be a medical issue, they’re going to look at every doctor, pharmacist, wholesaler, and patient as a potential criminal. That’s what law enforcement officials do. They look for criminals.
And so in its ongoing effort to stop people from getting high, the government has once again created an atmosphere of fear, distrust, and paranoia. This time, sick people are suffering because of it.