Reuters on the Painkiller Issue

Monday, June 18th, 2012

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.

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60 Responses to “Reuters on the Painkiller Issue”

  1. #1 |  Aresen | 

    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.

    And the Drug Warriors don’t give a damn who suffers.

    ‘It’s for the children’ and all that.

  2. #2 |  SJE | 

    This is the same DEA that thinks headless corpses and 50,000 dead in Mexico is a sign of success. Why do we even listen to these people.

  3. #3 |  Mike | 

    SJE, it is a sign of success. You see, if people use chemicals to be happy, then, um, bad things may happen. But if they are dead, they won’t be happy, so no bad things will happen. Everybody wins!

  4. #4 |  C. S. P. Schofield | 

    I have read the assertion that many of the overdoses associated with prescription pain meds are, in fact, kidney failure due to the DEA mandated inclusion of Acetominophen(sp?). While this sounds like the kind of bone-headed idiocy I expect from the government, the assertion was made in a comment on a Blog, and without reference. Does anybody here know anything about this? Is there any basis for it, or am I drifting into Area 51 territory?

  5. #5 |  Disgusted | 

    Hhhmmm, maybe it’s time that DEA agents, and the drug czar and all the congress-critters found themselves listed on a the Pharmacist Association ‘Do Not Buy’ list… so that when *they* want something more than an aspirin, they *can’t have it*.

    Wonder how many congress-critters getting whupped upside the head, like that, it would take to generate some common sense. I don’t think the number would be large.

  6. #6 |  Whim | 

    May we fervently wish for DEA Administrator Michele Leonhart to experience the frustration and humiliation that chronic pain sufferer Pamela Storozuk regularly endures because of the intemperate actions of the DEA:

    By herself one-day suffering from chronic pain.

    Does cancer of the spine sound suitably painful?

    Thought so.

  7. #7 |  Boyd Durkin | 

    making life a living hell for pain patients

    Martha Stewart was blasted by members of Congress (and sent to prison) for a small beans case of “insider trading”, while Congress was immune to “insider trading” laws. This hypocrisy had a result of making members of Congress realize annual returns on investments higher than just about any group in America–I guess Congress is just a collection of the greatest investment analysts in the world who choose to, instead, serve in Congress.

    No proof, but I’m a betting man and I think a similar story will come out how members of Congress and State Thugs (past and current) use pain killers at levels that would get them thrown into prison if they were a peasant. All while they deny people in pain the medication they need. These people are repugnant.

  8. #8 |  jeffk | 

    I read an article earlier this year stating that many of the overdoses are of Methadone, a low-cost narcotic that is used in place of safer but more expensive medications like Oxycontin and oxycodone. My wife, who has severe pain issues, went to a “pain clinic” where the doctors treated her like an addict, switched her to methadone, and focused on getting her off drugs instead of treating her pain. One particular “doctor” suggested aspirin as an alternative.

    I think it would do wonders to have some of those doctors, agents, and lawmakers experience even an hour of the pain that people like my wife and other pain patients experience every day of their lives. I suspect that would change their perspective quite a bit.

  9. #9 |  Dave Krueger | 

    Real criminals are hard to catch. They hide what they do so they won’t get caught and they know enough not to talk to other people about what they do. Much better for law enforcement to go after those who aren’t criminals because they don’t bother to cover up what they do and there are lot more of them which makes for a good supply of fresh meat.

    It’s not about fighting crime. That’s just the excuse they use. It’s really about expanding the cop, court, and prison empires.

  10. #10 |  elne | 

    Whim, no.. people care about cancer sufferers and even the DEA lets some get pain relief without shaming them. But severe chronic migraine more than 10+ days a month unresponsive to the typical ‘preventative’ and someone’s really screwed.

  11. #11 |  David Jones | 

    As a physician, I can tell you I am pretty sure there is no mandate to include acetaminophen in these pain medications. While many narcotics are available in combination with acetaminophen, you can get the narcotic alone in most (perhaps all) cases. There is a real problem with prescription diversion, and it is amazing what lengths some people will go to as they try to get multiple prescriptions filled at different pharmacies, go by the emergency room and try to get meds, etc. This needs to be controlled, but we need to find a way to address this that doesn’t limit supplies to legitimate users.

  12. #12 |  C. S. P. Schofield | 

    Dave Krueger,

    The problem with you stated position is that, by the evidence run-of-the-mill criminals aren’t all that bright.

    I think the real problem is that the Feds sincerely believe that they are saving helpless idiots from a degrading life as drug addicts. They have bought into the whole ‘war on drugs’ narrative, and why not? Hollywood has been tub-thumping for it in nearly every action movie for the last, what, forty years? The basic assumptions of television line up too. The only counter drumming comes from a few unappologetic old druggies, some pain patient activists, and nuts like me. If you grew up reading the mainstream media, weatching network TV, and going to basic shoot-em-ups, why weould you believe anything else?

  13. #13 |  el coronado | 

    #4, you’re right on about adding acetominophen & ibupfofen to high-powered pain drugs to “help them work better.” I’m a chronic pain guy, and have been aware that acet. isn’t the magic pill it’s made out to be ever since NFL stud Kenny Easley fried his kidney on them (and almost died) 20+ years ago. Adding ‘em to Lortab/Vicodin/Etc is like taping a BB gun on a 30.06 to “make it more effective”…..but that’s what they did. Why?

    Because that’s what the drug warriors DO. It goes back a long way: have read somewhere, maybe even on this blog, that back in Prohibition, the Booze Ninjas added (actual, for-real) *poison* to alcohol, and quite a few folks died from it. So y’all might wanna think about tossing your Tylenol and going back to aspirin. Just sayin’.

    Served ‘em right, really: they were breaking the *law*, you see. Promotions and commendations for everyone!!

  14. #14 |  Aresen | 

    @ C.S.P. Schofield

    The ‘run of the mill criminal’ is not one the Drug Lords that the Drug Warriors profess to be after.

    And the people who pass the laws damn well know that the Hollywood Drug Lord is a bogus fantasy. They just like the nice campaign contributions they get from the Police Benevolent Organisations, Prison Guards’ Unions, Prison Contractors, etc and are perfectly willing to look the other way. It’s not as if the legislators will ever be subject to a SWAT raid or have their dog shot, after all.

  15. #15 |  Anti Federalist | 

    [quote]“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.”[/quote]

    I’ll bet a $100 FRNs that this well meaning doctor hasn’t said a thing about, oh, I don’t know, TSA, in the past ten years.

    “I’m not doing anything wrong, what do I have to hide?”

    Welcome to a police state, doctor. If more people like you had stood up and denounced this as it was happening, then, maybe, it would not be happening to you now.

  16. #16 |  Anti Federalist | 

    [quote]“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.”[/quote]

    I’ll bet a $100 FRNs that this well meaning doctor hasn’t said a thing about, oh, I don’t know, TSA, in the past ten years.

    “I’m not doing anything wrong, what do I have to hide?”

    Welcome to a police state, doctor. If more people like you had stood up and denounced this as it was happening, then, maybe, it would not be happening to you now.

  17. #17 |  Dave Krueger | 

    #8 C. S. P. Schofield

    I think the real problem is that the Feds sincerely believe that they are saving helpless idiots from a degrading life as drug addicts.

    There are no bad people in the world. There are only those who are much more adept than others at convincing themselves that their viciousness towards others is justified.

  18. #18 |  C. S. P. Schofield | 

    Dave Krueger,

    I understand why you’d feel that way. I do too, sometimes. But the older I get the more I realize that people, by and large, do not check their assumptions much. I think that Prohibition was passed by a tiny minority that were angry that folks get drunk and a larger number who really thought it would help. I think that the Drug War is waged by people who have seen too many junkies, and can’t not try to do something. I’ve known a number of junkies. They were sad, wasted people. If, and I repeat IF, making drugs illegal and so forth would help them, I would be for it. But I’m suspicious of centralised solutions. I don’t believe that doing things for other people’s good accomplishes a lot. And that makes me very, VERY weird.

    The old saw is “Never attribute to mlice what is adequately explained by stupidity”. Extend that to “explained by insufficient sceptacism about what Everybody Knows” and I think you have most of the Drug War. It would be a lot more exciting if the people driving it were evil. But I don’t think they are. I think they’re stupid.

  19. #19 |  Highway | 

    CSP Schofield: Regarding the issue of acetaminophen in painkillers – yes, it is a significant hazard. Here’s an article from the NY Times in 2009 describing some of the issues around acetaminophen poisoning:

    http://www.nytimes.com/2009/07/07/health/07well.html?_r=1

    And it mentions that Vicodin and Percocet are both mixes with acetaminophen, and that Hydrocodone is not available by itself, and Oxycodone is, but is *much* harder to get. The government is far less restrictive (not unrestrictive, just less restrictive) regarding prescriptions of Vicodin and Percocet. So why the discrepancy? Because of the belief that the acetaminophen is a limiting factor in the dose, not because it ‘works better’. It’s bullshit to say it works better. If it did, then just prescribe Oxycodone and a Tylenol. But no, they want it together so that you can’t take more than a certain amount of the narcotic.

  20. #20 |  SJE | 

    CSP Schofield: acetominophen is seriously hepatotoxic (liver damage), responsible for 48% of acute liver failure in adults (FDA ref below). According to 2004 paper, acetiminophen and is the #1 cause of overdose (over 100,000 calls, 56,000 emergency room visits, 2,600 hospitalizations, and est 458 deaths. http://onlinelibrary.wiley.com/doi/10.1002/hep.20293/pdf.

    In 2011, the FDA asked manufacturers to limit acetominophen in combo products, including oxycontin, because of the dangers http://www.fda.gov/Drugs/DrugSafety/ucm239821.htm

  21. #21 |  C. S. P. Schofield | 

    el coronado,

    I’m gratified to have my impression reiforced, but do you have a citation? Has anything been written about it, either in medical journals or elsewhere? I’d like to be pushing this, it seems like it could get traction, but I need a foundation.

    Thanks

  22. #22 |  C. S. P. Schofield | 

    Highway,

    Thanks. That helps. There is at least a basis for making the assertion that acetominophen is being used the same way that poison was added to industrial alcohol during Prohibition. That, BTW, is widely considered to be one of the nails in the coffin of the Anti-Saloon League; their vociferous support of poisoning people who just wanted a drink.

    Let’s spread this far and wide.

  23. #23 |  Deoxy | 

    CS Lewis:

    Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.

    That explains a lot of the drug war.

    Real criminals are hard to catch. They hide what they do so they won’t get caught and they know enough not to talk to other people about what they do. Much better for law enforcement to go after those who aren’t criminals because they don’t bother to cover up what they do and there are lot more of them which makes for a good supply of fresh meat.

    That explains a lot of human behaviour, actually.

    If there is no check on performance, you collect lazy, useless people (like the public schools in America have done – yes, yes, I know good teachers are incredibly important, but the public school system depends entirely on the moral character of its teachers to make them good… yeah, that works so well!).

    But if performance can’t be checked reliably or are very difficult to check in any volume at all, to measure performance, you use a proxy – something that tends to follow the thing you actually want to measure.

    The problem with proxies is that none are perfect, and all can be gamed, to some extent. The longer a certain proxy is in use, the better the players become at gaming the system.

    Hence, if the proxy is “number of people arrested”, well, it’s easier to arrest those who don’t think they’ve done anything wrong and have nothing to hide.

    A horrendous example of this was mentioned, IIRC, on this site some time ago. To “incentivize” the social workers to get more children out of foster care and into good homes, the British government (again, IIRC – but it just as easily happen here!) offered cash bonuses for each child adopted.

    Well, babies get adopted easily, and other kids don’t. Stop and think about what you might do to get more babies into the system (if you didn’t care a lick about justice, morality, etc). That’s right, you’d look for (and even create) reasons to remove healthy infants from their homes so you could get them adopted out.

    Proxies and incentives – they must both be changed regularly to keep them fresh, or they get rotten.

  24. #24 |  StrangeOne | 

    C.S.P.

    I’ve had the same experiences with Drug Warriors. Many of them literally don’t think about their premises at all. “Drugs are bad so they have to be illegal. Since no one does illegal things that’ll make the drugs go away.” Its like a grade school understanding of how people behave and justice systems operate, but its the legitimate belief of far too many adults.

    I’ve talked to people who thought the war on drugs was to “help addicts”. I countered with the obvious questions: Who gets “helped” by being thrown in prison? If it’s a public health issue why is it run by cops and prosecutors instead of doctors? Why is it easier to get drugs in prison that just about anywhere else?

    Anyone that thinks about it for more than a minute immediately realizes that the system as it stands does nothing to help addicts, protect children, or inform citizens about the realistic dangers of drug use / overdose / dependency. Most of your common drug warriors simply never take that minute to think about it.

    Its only when friends and family start getting their lives ruined, not by drugs, but by the systems response to drugs do they ever begin to question the justice of it all.

  25. #25 |  Jim Wetzel | 

    “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.”

    You may not necessarily HAVE to lynch petty bureaucratic little would-be tyrants. Just show ‘em the noose once in a while.

    On second thought, screw it … let’s just lynch ‘em.

  26. #26 |  C. S. P. Schofield | 

    StrangeOne,

    I think that one of the things that is easy (at least for me) to forget is that most people don’t really pay that much attention to the politics and social issues that I’m interested in. They have lives, and their hobbies don’t include following social history. I’m strange. Both my parents were history teachers, and I picked up the habit; I try to understand what the hell is going on … and frankly it’s scary enough that I understand perfectly why most people don’t.

    On the other hand, what I know about running a contracting business, like that of a plumber for example, could be carved into the head of a pin with a cold chisel.

  27. #27 |  Elaine | 

    My husband was in a major motorcycle accident 8 years ago. He was on a motorcycle and a one-ton (big truck) top a hill in his lane. He suffered a broken rib, broken wrist, and an open book break of his pelvis. His rib never healed properly, and chips of bone from his pelvis ended up lodging in his hip joints. He has lost more than half his muscle mass, and about half his bone mass. Over the last 8 years he has dropped from 23 medications to 12. He has been lowing his levels of narcotic pain medication each year for the past 4. He found out a year ago, that yes, he has severe liver damage from the tylenol that was in his medication (he is now on a non-tylenol narcotic). I live in fear every day, because someone a couple of counties over was arrested the day after they picked up their prescription. Apparently one months prescription was enough to arrest them as a potential dealer. I don’t know how much they were on, but I know my husband can’t go without his medication. I also know that every month there is the possibility that the DEA will break down our door, take away my husband, our child, our home, and our savings. It’s hard enough caring for a child and a disabled husband, I have to live in constant fear of losing everything.

  28. #28 |  Pi Guy | 

    re: use of acetaminophen in conjunction with narcotic pain relievers

    I’m pretty certain that part of the reason for adding acetaminophen to, say, oxycodone to make make percocet (percodan isn’t so common any more but is oxy + aspirin) is that it allows it to be scheduled differently on DEA’s list. For example, pot’s a Schedule I drug – no medicinal value (according to the DEA) but percs, I believe because of the combination of the two pain relievers, are Schedule II.

    I am unable to verify this but seem to think it made sense when I heard (read?) it.

  29. #29 |  Other Sean | 

    Strange One #24 (and C.S.P.),

    I actually know a lot of cops and a handful of feds actively involved in the drug war. I even know an investigator whose whole job (which he bitterly hates) is dealing with “diversion” cases.

    This is purely anecdotal, but in my experience only the agents at DEA still believe uniformly in the drug war mission. Many of the others LEOs I talk to are perfectly happy to admit the drug war is a joke – if they believe themselves to be speaking among friends. In hostile or unknown company, well…of course they revert to a memorized version of the party line.

    One snag for them – as for many civilians – is that they find it nearly impossible to imagine what week one of legalization would look like. They know things aren’t working as is, but they simply can’t imagine society tolerating the switch to drug freedom. They are in a unique position to know just how messy and ugly that switch would be (think Hamsterdam).

    The other snag – this one unique to cops – is that law enforcement strategy has become completely dependent on drug possession as the lowest-hanging and most abundant fruit on the tree of evidence. Big city cops don’t catch burglars or robbers or murderers anymore – they catch guys who MIGHT BE burglars or robbers or murderers, when they happen also to be in possession of drugs. If those cops suddenly had to learn investigative skills that have been in atrophy since the early 1970s (see: Bunny Colvin, S3; E10), they’d have some problems. And because there are still plenty of vicious thugs out there, so would we.

    Naturally I realize this will disappoint anyone who is hanging his hat on the appealingly simple theory that cops are just mean, evil, cackling villains who drink the tears of children before work each morning. But I risk that to share what I have seen and heard…

  30. #30 |  DoctorT | 

    “… From 1999 to 2009, the number of deaths from narcotic pain pills nearly quadrupled…”

    These are the usual bullshit statistics the government uses to justify its war on drugs. The CDC changed the way it classifies death reports from medical examiners and coroners. If a person dies of any cause and has detectable levels of opiates, cocaine, amphetamines, barbiturates, tranquilizers, alcohol, etc., then it now is classified as a drug-related death. That’s where the quadrupling comes from. (The CDC pulled the same stunt with obesity: change the criteria and suddenly we have an obesity epidemic.)

  31. #31 |  DoctorT | 

    @27: Adding acetaminophen or ibuprofen-like drugs to an opiate painkiller does NOT alter its classification or its DEA reporting requirements. The reason for combining the drugs is to reduce both pain and inflammation. If a patient has severe pain without inflammation, the use of an opiate alone is better.

  32. #32 |  Other Sean | 

    DoctorT,

    Of course patients could simply take two pills, if inflammation control is that important. Given the massively different rates of tolerance between APAP and opioids, you must admit it’s medically irrational to bind them together.

    I think the larger point is: if lots of people were spoiling their livers on a non-narcotic medicine that was unnecessarily bundled with APAP, there would be a massive outcry, denunciations of big pharma, 60 Minutes special reports, etc.

    One reason the public may tolerate such dangerous bundling here is because they have a moralistic reason to feel indifferent to the victims.

  33. #33 |  Dave Krueger | 

    When you ask someone why they are drug cops or why they support the drug war, do you actually think they’re going to say, I don’t like people who use drugs and want to see them suffer? Hell, you wouldn’t even have gotten that honest a response from most people in a lynch mob at the turn of the century.

    I think antagonism toward those who engage in behavior a person doesn’t approve of (ie: people who are different) is a hell of a lot more powerful motivator than the idea that the world is safer if only we lock up pot smokers. I don’t think people would be nearly so supportive if the targeted population were people they identify with such as beer drinkers.

    The drug war defines a group of people that are socially acceptable to hate, provides a rationalization for it, and people have no problem jumping on the bandwagon. The same thing can happen with any group that seams different based on religion, race, sexual preference, how they dress, economic class, vocal accent, education, profession, etc, etc.

    I don’t think for a minute that those who support or engage in the drug war do so because they want to make the world a better place. The very best you can say for them is that they don’t care. Anything beyond that is going to be a rationalization to the effect that “drug users deserve what they get”.

    The drug war is state sanctioned persecution. The only good thing about it is that it will eventually end just as most persecution crusades end. Unfortunately, some new crusade will take its place.

  34. #34 |  Katie | 

    Dr T,

    Since acetaminophen is not an anti-inflamatory, I fail to see how it can be included. To the best of my knowledge, the principal effects of long-term acetaminophen use are kidney and/or liver damage, the pain of which often renders any minimal previous pain relief moot. It is, however, an excellent means of suicide – long slow and painful – but effective when taken with a glass of scotch. I watched a friend die that way and I won’t put acetaminophen in my ear, let alone my mouth.

  35. #35 |  Other Sean | 

    Dave Krueger,

    “The drug war defines a group of people that are socially acceptable to hate, provides a rationalization for it, and people have no problem jumping on the bandwagon.”

    Funny you should mention that. I recently asked a group of cops what would happen if the government outlawed candy bars and told them to go out and fight the black market.

    They all laughed. One of them said: “What do think? At first everybody would say ‘this is bullshit’ and next thing you know some of us would be posing for a picture next to a big ass pile of confiscated Snickers After that, game on.”

  36. #36 |  B | 

    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.

    How lovely that pharmacists are forced to do the police work without the ironclad immunity the real police enjoy.

  37. #37 |  perlhaqr | 

    David Jones: This needs to be controlled

    Why? Why not just let the addicts have the damned drugs they want? They’d stop clogging up the bloody ERs, faking injuries and malingering so they could get their hands on a bottle of pills.

    Oh yeah, and fuck the DEA.

  38. #38 |  CatoTheElder | 

    “it has unanticipated effects that have nothing to do with the problem”

    If the effects are entirely predictable, in what sense are they “unanticipated”?

    It doesn’t take a rocket scientist to figure out that patients will suffer when the DEA harasses doctors and pharmacies to restrict distribution of pain medications. Even the most retarded administrators and agents at DEA should be able to figure that out. It’s much easier to understand the DEA when one understands that these effects were indeed anticipated. One must recognize that many DEA types are same sort of sadists that opposed the use of anaesthesics by Sir Robert Liston and James Simpson back in the 19th century. Like their 19th century forebears, the DEA does care about pain, and wants to make sure that patients experience it in the fullest.

  39. #39 |  Duncan20903 | 

    What I want to know is do we, or do we not have less witches flying around undermining our society and turning law abiding, unsuspecting people into Newts? Witch hunts may seem like a dirty sordid affair on the surface but just think what our society would look like if there were a witch on every corner!

  40. #40 |  damaged justice | 

    CSP:

    http://www.psychologytoday.com/blog/archevore/201103/tylenol-and-the-war-drugs

    “Your government is determined to protect you from too much fun, even if it kills you.”

  41. #41 |  el coronado | 

    CSP –

    Citations? OK, will try. On the “Kenny Easley got his kidney fried by the OTC painkillers the Seahawks kept by the gross in the training room and urged the players to grab a daily handful” to stop those nagging aches & pains, just google ‘Kenny Easley + Ibuprofen’. You’ll get boocoo results, from wiki to the LA Times.

    On the ‘Revenooers done poisoned alcohol in the ’20’s thus killing possibly as many as 10,000 people’ (!!), try this one from ‘Slate':

    http://www.slate.com/articles/health_and_science/medical_examiner/2010/02/the_chemists_war.html

    Enjoy.

  42. #42 |  The State vs. the People, Government vs. Freedom (and other news…) » Scott Lazarowitz's Blog | 

    […] Radley Balko: Reuters on the Painkiller Issue […]

  43. #43 |  Mike Williams | 

    I’m a little confused. What does “diversion” mean in the context of this article?

  44. #44 |  Mike Williams | 

    Yeah nevermind the comment immediately above. Duh.

  45. #45 |  Joe Bar | 

    My Rheumatologist just reccomended I take Acetomenaphin daily, instead of Naproxen . Is she trying to kill me?

  46. #46 |  Pi Guy | 

    #31 @ DocT:

    Thanks for clearing that up. I think I’d heard/read that somewhere but, after reviewing the Schedules more carefully _after_ commenting, I had a tough time making that fit my premise.

    I get smarter every time I read here. :)

  47. #47 |  Boyd Durkin | 

    The drug war is state sanctioned persecution. The only good thing about it is that it will eventually end just as most persecution crusades end. Unfortunately, some new crusade will take its place.

    A large part of the state’s identity is persecution, not just the drug war, which helps you understand exactly how the state continues to exist. It will eventually end…in pockets here and there that move on without a state. Your last sentence sums up current status of the Arab Spring nicely.

  48. #48 |  CTD | 

    “As long as you have a law enforcement agency bringing a law enforcement warfare 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 enemy soldier. That’s what law enforcement officials drug warriors do. They look for criminals enemies.”

  49. #49 |  SJE | 

    Joe Bar: all drugs have side effects. Naproxen and other NSAIDs generally are hell on your stomach, and long term use will cause ulcers. The previous alternatives were Vioxx and Celebrex, but they are limited or banned because of cardiovascular complications. Acetominophen has clear liver and kidney toxicities. Interestingly, opiates are less hard on the liver, kidney and stomach, but do cause constipation and can (of course) kill you rather quickly in high doses.

    Unfortunately, the FDA and DEA focus too much on the harms/risks and not enough on the benefits. For example, short term Vioxx use is arguably safer than short term high dose NSAIDs (Naproxen, Ibuprofen, etc), and opiates are king for pain control. Of course, we are not allowed to take those risks ourselves.

  50. #50 |  SJE | 

    “Long term use” of NSAIDs: you can actually get an ulcer in a few weeks. Its hell.

  51. #51 |  Jeff | 

    The government and the dea,nice job,you take it away from legitimate people and its still on the streets along with the other drugs,all you have done is force people like me into finding something for relief on the streets ,because I cant take my legal script to my local pharmacy to get it filled,you mite as well arrest us all now,as we are already being treated like criminals….

  52. #52 |  BamBam | 

    They all laughed. One of them said: “What do think? At first everybody would say ‘this is bullshit’ and next thing you know some of us would be posing for a picture next to a big ass pile of confiscated Snickers After that, game on.”

    Which illustrates that they are uncaring evil people who believe that the mantra “I’m just doing my job” relinquishes them from any moral responsibility of their actions. It matters not how many lives are destroyed over immoral laws. They uphold the law and your issue is with politicians who make the laws.

    Which negates your statements in #29.

  53. #53 |  Other Sean | 

    BamBam,

    I’m afraid you’ve badly missed the point. If a cop talking to a civilian in a room full of other cops can ADMIT that the drug war is just as morally arbitrary as a hypothetical campaign against black market candy bars, then there is clearly a basis for understanding between us and them.

    But the path to that understanding is blocked when we retreat into the cheap and lazy refrain of denouncing all cops as “uncaring evil people”.

    Do you think mean teachers are the root cause of failure in public schools? Do you think the problems with our health care system can be neatly summed up by declaring that all nurses are insensitive bitches? Would you say the war in Iraq is a disaster because our enlisted men are just a bunch of dicks?

    Of course not. You would never say THOSE things, because you recognize them for what they are: counter-productive, thought terminating cliches that prevent you from getting at the moral complexities of the real world.

    So why say such things here? What on earth do you gain by personalizing and crudely simplifying what is so obviously a systemic and complicated problem?

  54. #54 |  GoodAsh | 

    ->They all laughed. One of them said: “What do think? At first everybody
    -> would say ‘this is bullshit’ and next thing you know some of us would be
    -> posing for a picture next to a big ass pile of confiscated Snickers After
    ->that, game on.”

    –>Which illustrates that they are uncaring evil people who believe that
    –> the mantra “I’m just doing my job” relinquishes them from any moral
    –> responsibility of their actions. It matters not how many lives are
    –> destroyed over immoral laws. They uphold the law and your issue is
    –> with politicians who make the laws.

    —-> Which negates your statements in #29.

    I have to say that the above are rather valid points. Where is the morality or conscience in these officers of the law? The real root of the problem surely is backstopped by money. It seems these days that policing for profit has become quite fashionable for all of the alphabet soup “for our own good” organizations. From the drug warriors, the local cops right on down to the politicians who want some money to fund their pet project. Federal, State and Local organizations have become hooked on the profit motive inherent in this sort of enforcement activity.

    Back to the moral issue on this, it is shameful that we would deny even a single person who is suffering pain in order to prevent someone from doing something for their own good. I have seen the effect of this war on pills first hand. A friend of mine, whose mother was sick with a terminal neuropathy, was in constant excruciating pain. The pain meds were the only reason her pain could be brought to tolerable levels so that she could get out of bed and do a few normal things like the rest of us. When she did not have her pain medication, she could not even stand the pain that came from her broken nerve endings sending pain signals. The conventional wisdom is that it is preferable to prevent someone from becoming an “addict” while relegating them to a state of mere bed ridden existence rather than treat their pain which allows them to regain some of the ability to live life again for the time they have left.

    I have also seen in the case mentioned above, how doctors have become so risk averse to writing scripts for her to fill her pain medication, that it became necessary for her to fly to another state every couple of months to see her previous pain doctor who was courageous enough to give the DEA the finger for the sake of his patient.

    This whole issue is superbly illustrative of what happens when human suffering can be converted into a for profit exercise at the behest of shameless single minded bureaucrats with no other purpose than servicing their narrow mandates for what they rationalize to be a just cause.

  55. #55 |  Vic Kelley | 

    I hope some of these people have the ability to leave the U.S. I don’t know where they could go but there have go to be other, better places out there that treat people humanely. This GD country is a disgrace because of crap like this.

  56. #56 |  Bergman | 

    Once again, I have to wonder. Practicing medicine without a license is a crime. Medical practice is not just the administering of drugs, it also encompasses taking a patient off of a drug regimen.

    At what point does an act of law enforcement cross the line into the practice of medicine without a license? The DEA is literally diagnosing patients as not needing the medicine actual doctors have prescribed.

    Are federal agents exempt from all laws?

  57. #57 |  Jeanne Hyatt | 

    Thank you, Mr. Balko, for writing this. I am a chronic pain patient. In addition to the doctors, this War on Drugs most definitely has now hit the local pharmacies and the legitimate pain patients in Florida and more and more states in this country. In the past 6 months I have had what was once a disabling but manageable condition turn into, as you said, a living hell. I wake up every day in excruciating pain that used to be invisible to most people I know. Because of my monthly prescription for opioid medication I was able to live a normal life, granted with some limitations but basically live like most people. I can’t work but I was able to go grocery shopping, cook dinner, run errands, help a friend by driving him to his doctor’s appointments and even go out once in a while for a meal. That all changed in January when I had to drive to 5 pharmacies to find my prescription. I thought it was just a temporary shortage but then it happened the next month, too. I was given strange looks and whenever I asked about the reasons why, I was given conflicting information. It was all so strange. I began googling everything I could and found a Facebook group of almost 100 members who were just like me – legitimate chronic pain patients having trouble getting their prescriptions filled in Florida. All had been profiled, denied, lied to and treated like criminals. I found some helpful suggestions. I was told I needed to “get on a list”, to keep an impeccable appearance and to not use the drive through but go in to the pharmacy. Some have had to take their medical records in to the pharmacist in order to prove that they needed the medications even though they had been receiving the same medications there for a period of 4, 5, and 6 years. Some have been told to try Mom and Pop pharmacies only to be charged high prices. Doing the pharmacy crawl every month is nearly impossible to do when you are in pain. So I asked my doctor for something that I “could” get filled. It wasn’t perfect but it was something. Then my doctor of 6 years, board certified in pain management and internal medicine, suddenly decided to throw in the towel and just stopped seeing all of his pain patients. I had to scramble to find another and even he seems to be pushing non-drug therapies. The added stress of not knowing from one month to the next if you will be bedridden with pain or able to function is maddening. It just makes the pain and fatigue worse. I try to advocate but I’m sick and it just gets more and more frustrating. When 98% of everything one reads is anti-opioid and then reading about the struggles of more and more people every day, it gets very frustrating and I feel very helpless. I find I need to stop working for change because it just makes the pain worse. So, thank you, again, and thank you to all who have commented. It is only through reading articles like this that I am given renewed hope.

  58. #58 |  Nancy | 

    Mr. Balko,

    Thank you for being one of the few people in the media who seem to understand how devastating this war ON PAIN PATIENTS has become for us. For those of us who rely on the use of long term opioid therapy in order to survive, and have major, diagnosed, pain conditions….it is unfathomable to us that the very government we rely on to protect us, is the one abusing and neglecting us! With media attention to groups like, PROP, who recommend taking, “Tylenol” and to use other forms of non-opioid pain relief….people are buying into this idea that other treatments will work for us. if non-opioid pain treatments worked exclusively for us, we wouldn’t be taking opioids!!!! WE ARE the people who have used these as LAST resort, because we have tried everything else….for YEARS, before we could find a doctor willing to prescribe pain medications to us. I suffer from a rare, genetic, connective tissue disorder called, Ehlers-danlos syndrome. Patients with EDS produce faulty collagen, which acts as the “glue” in our bodies…..it effects every organ system, blood vessel, GI tract, etc…. The results are devastating…. Loose, unstable, hypermobile joints that constantly dislocate and subluxate, multiple surgeries, constant injury, the list is endless! There is no cure, and without opioid medications (if we have been lucky enough to find a doctor to prescribe them) would be bedridden. We have severe, intractable chronic pain, in addition to major episodes of acute pain…sometimes DAILY. Before I found proper pain control with opioids, I was suicidal with pain. You cannot live with THAT kind of pain everyday, and have any HOPE. To think of going back to THAT horrible, pathetic, agonizing existence is devastating. The idea that I could walk into my pharmacy one day, to find out they no longer carry my medicine, or that their is a shortage….is TERRIFYING! What’s even more terrifying, is that it is INTENTIONAL…. a massive pain crisis, and withdrawal, perpetuated by MY own government. Putting my life at risk, because people who aren’t supposed to be using this medicine overdosed on it. SO,….what? Punish people who already suffer tremendously…..so that determined addicts can just “switch” their drug if choice? Let’s just say, that the kind of anxiety that this crisis is putting on legit pain patients, doesn’t exactly help our already stressed, painful bodies. I feel so terrible for what patients are going through in Florida….it is ABUSE. Well….I’m next, I guess. My insurer, BCBS of MA has decided that people like me, don’t need any relief from severe, intractable, incurable pain, for any longer than 15 days. Apparently, all my “extra” doses laying around could pose a threat to society! SO….lets get this straight! My government wants me to suffer WITHOUT pain control, and my “health” insurance company wants to tell me I should be cured from INTRACTABLE pain in two weeks? Okay, got it.

  59. #59 |  Elaine | 

    @ Doc T. I never said it did. A schedule 1 narcotic is a schedule 1 narcotic no matter what you add to it. Oxycodone and hydrocodone are both schedule 1 with or without acetaminophen. The DEA will not specify how much of a schedule 1 drug qualifies as “potential dealer”. Therefore you can’t know if you are over their arbitrary number or not.

  60. #60 |  Elaine | 

    Thanks to the DEA’s war on Pain Patients, we must travel 5 hrs each way to take my husband to the doctor. Why? His Doctor moved. Get a new one? Good luck. There are no Doctors with in a 200 mile radius of us that will take on chronic pain patients. Why? They are afraid of the DEA. We have switched pharmacies twice, because the one pharmacy quit carrying narcotics all together, and Walmart carries such limited quantities per month they would often run out before my husbands could be filled. We thought about going to Walgreens, thankfully they were honest with us and told us that we would have had the same problem with them that we did with Walmart. The town nearest us has a nice new hospital. If any doctor wants to see their patients at that hospital, even if they are not on staff, they have to sign a contract with the hospital agreeing to never treat chronic pain patients with schedule 1 narcotics. They have to agree to never prescribe them for a patient for more than 3 months in a year, and not to prescribe it to any patient who has been on them for three or more months in the last year.

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