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 |  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….

  2. #2 |  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.

  3. #3 |  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?

  4. #4 |  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.

  5. #5 |  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.

  6. #6 |  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?

  7. #7 |  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.

  8. #8 |  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.

  9. #9 |  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.

  10. #10 |  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.