Not a War on Patients

Tuesday, November 13th, 2012

I still get a couple emails like this each week in response to the painkiller series I wrote for Huffington Post back in March.

My husband died 4 years ago from a massive cerebral hemorrhage. He had multiple health problems but the worst one was a severely degenerative disc disease. Because he was on Plavix he was not a candidate for surgery. He took 80 Oxycontin daily for 3 years and 9 months prior to his death. But then the  doctor at the pain management clinic he went to regularly informed him that the clinic was quitting prescribing oxycontin. In those last three months of his life he was . . .  in agony. All he wanted to do was be able to walk across the living room to get to his potty chair without pain. He wanted to sleep but couldn’t because of the pain. He was incapacitated by the pain, and not because of drug abuse, but because the doctors at the clinic were afraid of losing their licenses. If I had known he was going to die, I would have found some way to get the Oxycontin for him. He was never high or stoned. He just wanted to be free of pain. As much as I miss Roger, I am glad he is now pain free.

But remember, this federal campaign against opiods is not a war on pain patients.

I know because the drug czar himself has assured me that patients like Roger have never had any problem getting the medication they need.

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34 Responses to “Not a War on Patients”

  1. #1 |  Joshua | 

    Let’s not forget that the same type of person who supports an aggressive war on drugs generally also supports using torture in the war on terror. To put it another way, they have no problem inflicting extreme pain on a person they don’t know in order to achieve their aim.

  2. #2 |  BamBam | 

    Don’t forget that the root of the stated goal is to control others. The goal is disguised with many platitudes — “good of society”, “for the children”, “for the country”, etc. but the solutions to the purported problems address superficial issues with a grotesquely violent response. One can only surmise that the problem solvers are sadists, control freaks, and liberty haters.

  3. #3 |  glasnost | 

    Usually, I’m more or less neutral on this issue, i.e. I don’t have any real reason to disbelieve RB on this topic, generally not being in favor of the war on drugs.

    However, I recently took an airplane trip, ending up sitting next to a nice young black guy with a work background in the mental health industry, having moved on to greener pastures of higher education. Very little good to say about the crappy state-run mental-health treatment offered by his home state, although most of the problem involved a dire lack of funding and the neccessary choices, rationing or cheap/crappy service, pick your poison the end. (Private charity mysteriously does not rush in to fill the gap, by the way, but I’m off topic).

    Anyway, this guy found that most of the heroin addicts he ran into during this time on the job were formerly nondrugusers who had medical problems, were prescribed oxycontin and other opoids, and developed an addiction. They turned to heroin, and into life-ending zombies.

    He also told me that most OD events came from attempting to quit, having your body lose its built-up tolerance and while your brain retains it, and then starting again.

    Poor people can’t afford heroin for long. Anyway, the point is, this guy told me that there were nonopoid painkillers that worked just as well as opoid painkillers, and that the medical industry bankrolled the continued use of opoids to their financial benefit.

    I don’t know if he is right, but his beliefs were shaped by his experiences. This is a real sad letter, and people whose future involves indefinite, chronic pain at high levels are the best case for opoids. But overprescription of opiods is a big problem. It turns every twentieth, or hundredth, etc, formerly healthy person into a heroin addict. Some pushback on that overprescription is a good thing. I’m not convinced that RB has looked into the other side of this argument. After all, The Government Is Doing It, So It Must Be Evil.

  4. #4 |  glasnost | 

    To clarify, a good version of The Other Side of The Argument is not that people like the person in this letter shouldn’t get opoids. It sounds like, at a minimum, a campaign to discourage overprescription is being badly targeted at the moment, with very bad secondary consequences. Letting doctors prescribe whatever they want with no liability for the consequences is also no panacea. It doesn’t take maliciousness for that to produce bad outcomes, just ignorance. And then you get things like thousands of shoddy hip replacements being implated in people, or a million people being prescribed Vioxx, a few hundred thousand extra heart attacks for no reason, with no consequences to the honest mistakes made by the doctors involved.

  5. #5 |  Peter VE | 

    A friend had suffered a broken back and torn foot when the ambulance he was a tech in was hit by a drunk. After several years on a “pain contract”, the doctors chose to cut off his pain meds. He killed himself. Grow p. somnif. for your own use.

  6. #6 |  Big Texan | 

    Just like the generals in World War 1 sending those poor soldiers to their deaths, these pain patients are just meat for the grinder.

  7. #7 |  Cynical in New York | 

    #1

    I would agree I would also inject that one can’t be against the Patriot Act (and similar fascist laws) but then cheer on the War on Drugs.

  8. #8 |  Not Sure | 

    “Private charity mysteriously does not rush in to fill the gap, by the way, but I’m off topic.”

    There’d be a better chance of that happening if government didn’t suck up as much of peoples’ incomes as they do. I know of charities I’d help if I got to keep more of the money I earn. But then, the people who run the government know better than I do what my money should be spent on, I guess.

  9. #9 |  Ghost | 

    To paraphrase Alex from Grandma’s Boy, “Thedrug czar’s a fuckin liar, Radley!”

  10. #10 |  Radley Balko | 

    Glasnost:

    From what I understand, accidental addiction can happen if you have a doctor who is inattentive and a patient predisposed toward addiction, particularly if the patient is prescribed too many opioids for a nonserious injury. But I’ve also heard lots of addicts blame their addiction on doctors because it’s easier to justify to themselves than to take responsibility for their own actions.

    The thing that makes me doubt the guy you talked to his that he said “most” heroin addicts he runs into started out on opioids. That just isn’t plausible to me. I can see heroin addicts turning to Oxy if it’s easier to get from pill mill clinics than it is to find heroin. (Which might have been true at one time, but I doubt is true in most places anymore.)

    But not the other way around. Even among the people with whom I strongly disagree on this issue, I haven’t heard many scare stories of that started with an innocuous opioid script and ended with the patient shooting street heroin. I’m sure it has happened somewhere, at somteimte. But “most” heroin addicts? Seems doubtful.

    Finally, I have no idea what the drug companies do in terms of marketing and promotion. I can tell you that when I tried to send Purdue Pharma a copy of the paper that I commissioned on this issue when I was at Cato–just to let them know about it–they ran like hell. They were terrified of pissing off the DEA. They returned my phone call only to tell me never to call them again. They even gave Joe Califano a million bucks to produce a report attacking their own product. (It didn’t work — the DEA nailed them anyway.) They’ve also done a crappy job sticking up for the doctors that the government has been targeting.

    That isn’t to say the pharma companies aren’t pushing the hell out of opioids behind the scenes. I’m just relaying my own experience. And that would be that they seem to be too afraid of the DEA to stick up for themselves and their product.

  11. #11 |  Brandon | 

    Glasnost, you are conflating “Liability” with “having their licenses taken away despite not having done any actual harm, and also possibly being imprisoned.” But that’s pretty consistent with the level of the rest of your posts, so I guess I shouldn’t be surprised.

  12. #12 |  el coronado | 

    Glasnost, whether you realize it or not, a line in your comment #4 nicely encapsulates the idiocy of government supervision of docs RXing pain meds. I quote: “Letting Doctors prescribe whatever they want with no liability for the consequences is no panacea.” I further gather you pretty much subscribe to this view.

    OVERLOOKING ENTIRELY THE FACT THAT A DOC WHO DOES THAT FACES “CONSEQUENCES” FROM BOTH HIS STATE MED BOARD AND THE SWARMS OF LAWYERS DESPERATE TO SUE A DOC FOR ANY OUTCOME LESS THAN ‘PERFECT’……..you seem to think the proper guidance and supervision can & will come from power-mad bureaucrats – who may be and probably *aren’t* M.D.’s – who sit at a desk 2000 miles away. Whose only knowledge of the case, the patient, and any extenuating patient peculiarities or odd specifics (extremely high opiod resistance? pain levels much higher than standard norms for this condition?) is limited to the only info the software that flagged the file is programmed to tell him: is there any deviation from normal/standard treatment protocol? IOW, you want medicine run exactly the way the military genius LBJ ran the war/bombing in Vietnam: the idiot boss calls the guys actually there on the scene who actually know what they’re doing and say, “Today, Ah want y’all to do this. Bomb _here_, but not _there_. Got it?”

    No over-the-top disrespect intended here, but that kind of “thinking” is usually only seen in politicians, central planners, and fucking idiots. I invite you also to google the name “Richard Paey” sometime – and then pray real hard that neither you nor a loved one ever becomes a victim of chronic pain.

  13. #13 |  Tactical Nuclear Penguin | 

    “Anyway, the point is, this guy told me that there were nonopoid painkillers that worked just as well as opoid painkillers, and that the medical industry bankrolled the continued use of opoids to their financial benefit.”

    I don’t think ANY opoid is under patent, but a lot of non-opoids are, so just that would prove his argument false.

    But even if it was true, arguendo, there are often reasons why a certain patient HAS to be prescribed opoids or be in pain: Entire classes of non-opoids conflict with other vital medicins, and if the few that don’t conflict are ineffective, then its opoids or nothing.

    I’ve seen that in a close relative: other vital medication restricts the choice to three non-opoids, all of which are ineffective, and some opoids. And every new doctor insists on trying all three before even thinking about opoids. But by that time they’ve decamped to a position elsewhere, so a new doctor starts the cycle again.

    Except one, who prescribed a non-opoid with a life-threatening interaction. And when asked about it said “Yes they say those medicins should never be combined, but in some cases it still works, supposedy”…

  14. #14 |  MamaLiberty | 

    I spent 30 years as an RN, the last 14 in hospice care. As a advanced practice nurse, a clinical specialist in pain and symptom management, I can tell you that actual addiction is incredibly rare for properly managed and medicated chronic pain patients.

    “Addiction” is a generic term applied to a great many physical and psychological manifestations of personal behavior. Personal behavior is the responsibility of each person alone and, as long as he/she does not aggress against others, is nobody else’s business. When people do aggress against others, THAT is the problem and must be addressed as such. It has little or nothing to do with what substance they choose to ingest or the reason they choose it.

    A proper understanding of what “addiction” truly means, how it forms, and who is responsible would solve the problems most people have with pain medications. It is no accident that the government manages to keep everyone misinformed and hysterical about this – as with so many other things. Forget safety or effectiveness… their goal is CONTROL, and nothing else.

    The question really is… who gives the government the authority to control our lives in any way? We do… and we will suffer as long as that is true.

  15. #15 |  The Late Andy Rooney | 

    glasnost: Even if most heroin addicts started off on legal painkillers, that doesn’t tell us much. It would rather look at how many users of legal painkillers end up on heroin. Very few, I would bet. The claim that “most of the heroin addicts” started on legal painkillers doesn’t tell us much about legal painkillers, though it may say something about heroin addicts (or potential heroin addicts). Some start on legal painkillers, some start with pot or alcohol. But most users of legal painkillers, pot, and/or alcohol don’t become heroin addicts.

  16. #16 |  Boyd Durkin | 

    Obama’s Drug Czar (in the same article) explained that he ended the “war on drugs” the first day he took the office!

    Good news, everyone! We’ve just been misinformed!

    Private charity mysteriously does not rush in to fill the gap…

    “Worst development of 2012″: People are introduced to the term “free market” and immediately start blasting it without knowing what it actually is. I’m looking at you, John Stewart.

  17. #17 |  Boyd Durkin | 

    this guy told me that there were nonopoid painkillers that worked just as well as opoid painkillers, and that the medical industry bankrolled the continued use of opoids to their financial benefit.

    Profits are not limited to opoid pain killers. Companies are adept at making profits off of just about anything. Especially with an ambitious DEA on hand to shoot the competition (and not shoot you if you pay up).

    As far as “heroin addicts started with legal pain killers”, I can tell you that most prostitutes started with kissing someone. Not that I want to cast prostitution in a negative light (I do not), but you have to be careful about the conclusions you make.

  18. #18 |  Yizmo Gizmo | 

    As far as “heroin addicts started with legal pain killers”…

    Little known fact.
    Heroin was invented to replace morphine as a result of the horrible
    dependence/addiction that morphine often led to.
    Go Ask Alice.

  19. #19 |  Martin | 

    This guy on the plane clearly isn’t a physician, or a nurse or pharmacist for that matter. Unless you’re talking headaches or neuropathic pain, nothing comes close to working as well as opioids. Period. In many cases, it’s all we have. And about pharma pushing opioids–maybe some of the newer ones that have fancy extended release packaging or something, but otherwise this is silly. Many opioids are generic and among the cheapest medications available, at pennies per dose. At least in this case, a pharma/medical conspiracy is nonsense. Further, at university hospitals, anyway, pharma can’t push anything anymore (I’m ambivalent about this–physicians of course aren’t immune to bias, but patients, especially the poor, sure miss those free samples).

    Most people who become addicted to prescribed opioids have been on them for long periods of time. Opioids do suck for chronic pain. But I think that the best we can do is just be honest w/ patients about the risks, and let them make an informed decision. Pain or risk addiction? We then need to be more proactive about not losing them to follow-up.

  20. #20 |  glasnost | 

    Well, an anecdote from a guy on a plane is not exactly equivalent to a peer-reviewed study. So I could be wrong. I can tell a story where most new heroin addicts plausibly come from legally prescribed opoids, based on two assertions:

    #1. Overwhelming knowledge that heroin use is more or less suicide, less awareness of the opoid nature of various painkillers and the risk potential.
    #2. A drug that starts out expensive and gets steadily more so, thus requiring a user base of nonpoor people, which correlates roughly with people who have historically avoided severe addiction problems. (again, don’t know).

    Not exactly conclusive, I’d love to see data.

    Maybe industry has no stake in the issue either way, I don’t know. Nonlibertarians can agree that the guy in this story ought to have been able to get whatever he needed to deal with his issue.

    Not really interested in debating the larger issue of medical regulation with the peanut gallery. Good luck with the state med board and the civil lawsuits. Try a quick google on our comparative rate of avoidable medical errors vs. the OECD.

  21. #21 |  glasnost | 

    The people pointing out that nonopoids don’t do the job sometimes for various medical reasons.. okay, I get it. The productive question is, why can’t the DEA come up with more objective guidelines that make more sense, avoid intimidating doctors who want to fill real need, and continue to disincentivize prescribing opoids for broken ankles (this guy’s anecdote) if there’s a perfectly good alternative?

    Unless you think we’re storming the barricades soon, the point of this advocacy is to convince the bureaucracy that changes are needed, so a demonstration that there are no feasibility hurdles would be useful.

  22. #22 |  Supreme Court Declines to Tackle Prosecutorial Misconduct Case - Hit & Run : Reason.com | 

    […] regular e-mails from patients suffering due to the feds’ scrutiny of prescribing doctors. His latest letter, about a man suffering in agony for the last three months of his life, is a real […]

  23. #23 |  Brandon | 

    Wow, glasnost. Arrogant, nonsensical and stupid. You’ve almost hit for the cycle.

  24. #24 |  albatross | 

    The war on painkillers is actually pretty easy to separate from the war on drugs. You could have an entirely consistent position that says:

    a. Narcotics should be illegal.

    and

    b. Police, prosecutors, and judges should be extremely reluctant to get between a patient and his doctor and try to micromanage how the patient’s pain is managed.

    My guess is that the majority of people would agree with (a) and (b), and that the war on painkillers is the result of bureaucratic and prosecutorial overreach, in a world where they have too much power and not enough adult supervision. So while I suspect drug legalization is a fight we’ll go on losing for awhile, rolling back the DEA harassment of pain doctors is something that would have substantial popular support if it caught a lot of peoples’ attention.

  25. #25 |  albatross | 

    I wonder how many of the people being treated with opiates for pain, longish-term, are actually socially problematic if they become addicted. I’m assuming someone in a nursing home or hospice who is addicted to morphine or something is not actually a big social problem, since he’s not going to be, say, driving a car while doped up, or messing up his career because of his drug habit, or leaving his wife and kids unsupported as a result of his drug habit. I assume it’s easier to give opiates in these cases (I know they’re commonly used to treat terminal cancer patients), but I don’t really know.

    I guess the group of people that everyone worries about wrt addiction is relatively young and healthy people. If they either have some visible injury that requires oxycontin, or have some hard-to-see cause of pain (like back problems, which can be extremely painful and very hard to do anything about), they can become dependent on the pain medicine both because of ongoing pain and because of addiction, and then this can cause them a lot of problems later on. (Of course, one big source of those problems is the difficulty of getting more oxycontin, which could be resolved by legalization.)

  26. #26 |  Supreme Court Declines to Tackle Prosecutorial Misconduct Case - Unofficial Network | 

    […] regular e-mails from patients suffering due to the feds’ scrutiny of prescribing doctors. His latest letter, about a man suffering in agony for the last three months of his life, is a real […]

  27. #27 |  joeNTexas | 

    As someone well acquainted with pain and a long term user of opiates, I think that people confuse the terms addiction and dependance.

    , I know full well that my body has a physical depandance from that use. The goal of my taking any of the multiple drugs I take daily, is too 1) stay alive a Tad bit longer and 2) having the mind numbing pain I life with controlled just a bit.

    If my goal were to be pain free, I can forget it. Wont happen. But after many years of trying various combinations of drugs from over the counter at one end to opiates on the other, I found just the right balance of function and pain relief that works for me. It took me, working with my doctors, almost four years before I got to opiates. I take the lowest possible level that works for me. I have many times, with doc supervision, changed my plan to see if the underlying issues are still really needing the opiates.

    I do have a physical dependance, just as I do with the several cardiac drugs I take every day. In fact it is more so with the cardiac drugs. Without them I die.

  28. #28 |  Rick H. | 

    glasnost: I’m not an expert on prescription opioids. But I am an addict who’s been off heroin for 21 years, and I can say that your airplane anecdote, and the conjectures you’re making, ring false to me.

    Just a few comments: I’ve spoken with thousands of addicts in recovery, and honestly only maybe two or three of them have ever used the “I was prescribed these pills, and next thing I knew I was shooting smack” explanation for their habit. I wouldn’t call it a myth, since I’m sure it does happen, but it plays right into the narrative of “pure, innocent _______ getting unwittingly corrupted by the evil dope” that’s long been part of this country’s toxic, racist history of prohibition.

    Other people here have made the point that for pain relief, opioids are the best (and, were it not for the WOD, cheapest) way to go. These drugs don’t cause liver and kidney damage, ulcers or tremors, like non-opioids usually do. In fact, as part of Nixon’s drug war, our wonderful government encouraged the addition of acetaminophen to vicodin, basically poisoning patients’s livers to discourage prescribing of the drug (after decades, the FDA seems to be slowly backpedaling on that one).

    Also, the idea that “nonpoor people…have historically avoided severe addiction problems” is totally false. Addicts come from all economic classes. It’s just that money and status can buy someone a degree of social insulation from many horrible government policies; poorer folks don’t have such a luxury.

  29. #29 |  Hugh | 

    MAMALIBERTY – you are wise.
    Thanks for explaining real life so clearly.
    Next time you are in Portland OR look me up and my wife and I will take you out to dinner.

  30. #30 |  Joe | 

    as someone who actually has a steady prescription for opiates, i must ask one question:

    80 Oxycontin a day? i am surprised this did not end up in huge vomiting sessions every day or an overdose.

    anyone who requires that much Oxy needs to revisit what meds he is taking, i mean for Pete’s sake, that is almost 5 an HOUR. I take 5 a day (have for the past three years) and i can tell you two things happen everyday: 1. heavy nausea by the last dose; and 2. i get the nods and unfocused vision.

    if someone requires 80 pills a day, they have the wrong meds or should be inpatient. i cannot for the life of me understand how someone can take that many pills and NOT overdose. again, this is coming from someone who takes this stuff everyday

  31. #31 |  John C. Randolph | 

    It doesn’t surprise me in the least that an apparatchik with the title of “czar” is a sadistic son of a bitch.

    -jcr

  32. #32 |  John C. Randolph | 

    ” The productive question is, why can’t the DEA come up with more objective guidelines that make more sense,”

    Because that’s not the DEA’s purpose. The DEA is a terrorist organization, whose mission is to strike fear into anyone who disobeys the government.

    -jcr

  33. #33 |  albatross | 

    John:

    I just don’t understand it. We put a guy in charge of an agency full of armed goons and give him the title of “czar,” and it doesn’t make him behave nicely. Who could have forseen this?

  34. #34 |  MamaLiberty | 

    Thank you, Hugh! I do appreciate the offer, but I will never fly again until the ticket agent is free to offer me complimentary frangible ammunition for my carry gun…

    And I don’t see that happening – at least not any time soon. :)

    Would love to talk… mamaliberty – at – rtconnect – dot – net

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