Category: Pain Treatment

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.

Reminder: The Media Isn’t Liberal, It’s Statist

Monday, November 5th, 2012

The Boston Globe today editorializes against medical marijuana and physician-assisted suicide today, both of which are on the ballot in Massachusetts. Why? Because neither ballot measure gives state bureaucrats sufficient control over over the lives of people who live in Massachusetts.

From the marijuana editorial:

With any other legal drug, patients would expect straight answers — they’d assume, almost unconsciously, that the FDA was protecting them. There’s no such backstop for medical marijuana. Even the wisest physicians wouldn’t have enough data to make definitive judgments . . .

Certainly, any regimen for medical marijuana that’s finally adopted should ensure that only those who demonstrably need the pain relief are getting it.

But in the end, Question 3 isn’t the right answer to a complicated policy issue. There are simply too many inherent problems in asking state officials to oversee a legalized system of growing and distributing a drug that hasn’t been subjected to the federal approval process.

Question 3’s heart is in the right place, and its architects have made a solid effort to learn from the mistakes of California and Colorado. But ultimately, the only truly safe way to legalize marijuana will be through the FDA, with doctors providing prescriptions and licensed pharmacists dispensing the medication.

In the meantime, let the patients suffer, the black markets prosper, and the raids continue. I mean, God forbid we pass a law that gives your average rube the tiniest bit more power to make his own decisions about what he puts into this own body. I mean, what if this law were responsible for someone using marijuana to get high?

And from the physician-assisted suicide editorial:

Reasonable people can disagree passionately about Question 2, but a yes vote would not serve the larger interests of the state. Rather than bring Massachusetts closer to an agreed-upon set of procedures for approaching the end of life, it would be a flashpoint and distraction — the maximum amount of moral conflict for a very modest gain . . .

Instead, Massachusetts should commit itself to a rigorous exploration of end-of-life issues, with the goal of bringing the medical community, insurers, religious groups, and state policy makers into agreement on how best to help individuals handle terminal illnesses and die on their own terms . . .

Physician-assisted suicide should be the last option on the table, to be explored in a thorough legislative process only after the state guarantees that all its patients have access to all the alternatives, including palliative care.

” . . . would not serve the larger interests of the state.” Doesn’t get much clearer than that, does it?

That last bit of emphasis is mine. Interesting what happens when you take these two editorials together. We can’t trust doctors and terminally ill patients to come to a decision about allowing a patient to peacefully, painlessly end his own life, because all of the experts, politicians, and elites haven’t yet decided what’s best for the patient. And we can’t let that same patient relieve his pain with marijuana, because the experts aren’t yet in agreement about the benefits of the drug (in part because the same bureaucratic structure refuses to allow the drug to be used for medical research), and in any case, because the proposed law doesn’t give nearly enough power to government to keep the drug away from people. (The Globe also endorses restricting access to prescription painkillers, by the way.)

The message the Globe editorial board is sending to people with chronic pain and terminal illness is pretty clear: Government power is far more important than your pain. So just fucking suffer.

Morning Links

Friday, October 5th, 2012

Maggie’s Tuesday Links

Tuesday, July 17th, 2012

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.

Morning Links

Tuesday, June 5th, 2012

Not a War on Patients

Tuesday, May 15th, 2012

In the name of preventing the diversion of prescription painkillers, the DEA is causing unneeded suffering in America’s nursing homes.

Meanwhile, here’s an email I received today from a pain patient in Tennessee.

Hi Mr. Balko. First, thank you so very, very,  much for being the “voice” for all of us chronic pain disease people. I have a rare disease called RSD/CRPS. It is rated the highest of all pain diseases on the Mcgill Pain Scale. It is rated higher in pain than child birth or the loss of a digit. I am on a fentanyl patch and other meds as well. I have recently been informed that the pharmacies near me will no longer fill opiate pain meds! My husband has to drive all over the state to find a place that will fill my medicine. I would be willing to talk to you if it will help me and others with the nightmare we are living. Again, thank you for what you are trying to do. We need you.

After my Huffington Post series on chronic pain, I created a file for emails from pain patients who can’t find treatment. It’s up to 300 messages.

But they must all be lying. Because the drug czar assures me such people don’t exist.

Arrested, Jailed for a Legitimate Pain Script

Tuesday, May 8th, 2012

Doctors prescribed a Texas woman a strong narcotic after she shattered her knee in Haiti.  And then . . .

“They gave me a pretty high, heavy duty narcotic, Norco, as a painkiller going forward and I had used that up. It had been a month and I had called for my refill,” Lenhart said.

The pharmacy called Lenhart to ask her exactly what time she would be in pick up her prescription. She thought it was odd, but told the pharmacy what time she would be there.

Still on crutches and unable to drive, a friend of Lenhart’s, drove her to a CVS Pharmacy in Oak Cliff.

She wasn’t able to pick up her prescription because a police officer arrived to pick her up.

“He was like ‘we need to go outside,’” she said. “I was on crutches and I had a permanent IV line in my arm. I had a big leg brace. I asked him if it was necessary and he said yes and he rather policingly escorted me out the front door and into the back of a waiting patrol car.”

Lenhart was so stunned, she didn’t think to ask the officer questions. The officer explained to her what was going on.

“He said, ‘Well we believe that you have forged your pain pill prescription and we are calling your doctor now. But I’ve worked with this pharmacist a number of times and he’s never made a mistake,” Lenhart said.

The officer then took her the Dallas County jail, where she remained overnight.  After she was released on bond, she was charged with obtaining a controlled substance by fraud, a felony.

“I couldn’t go back to work until HR had received the paperwork that this was a mistake from my attorney,” she said.

Dallas police later dropped the charges after speaking with Lenhart’s doctor.

These idiots couldn’t even bother to call the woman’s doctor before tossing her in a jail cell.

Lenhart’s story has been making its way around the web the past few days, and has been generating the appropriate outrage. But it shouldn’t be all that surprising. This is the perfectly predictable outcome of all this painkiller hysteria of late. It’s bad enough coming from the usual drug warriors. But because there’s a big evil pharmaceutical corporation to play the villain, we now get progressive outlets like ProPublica, and Alternet and Salon spitting out the government’s hype without the least bit of skepticism—or concern for pain patients.

You can’t really blame the pharmacist, here. She risks arrest and criminal prosecution if some overeager prosecutor looking to make a name for himself decides she hasn’t been sufficiently suspicious of her customers. Think about that. The government will now throw you in jail for failing to be suspicious enough of your fellow citizens. (And not just with painkillers — remember this monstrous injustice?)

Don’t blame her employer, either. The DEA recently shut down two CVS stores in Florida because federal drug cops thought the stores should have been turning away more people who came to fill pain medication prescriptions. Not only that, the agencies also attempted to shut down the wholesaler who supplies those stores for not being sufficiently suspicious of them, a move that would have left thousands of patients in several states without access to the medication they need.

The government has created a poisonous, paranoid atmosphere in which every player in the painkiller process from manufacturer to patient has been deputized to police every other player, to the point where anyone who doesn’t continually question the motives and actions of everyone else risks losing his livelihood, or even his freedom.

But Drug Czar Gil Kerlikowske personally assures me that none of this hysteria is affecting patients. People suffering from pain and conscientious doctors have nothing to worry about, Kerlikowski promises. Just trust him on this one.

Yeah, so tell that to Anne Lenhart. Or to the desperate pain patients who have been emailing me since the most recent doctor went down.

You are sorely missed, Siobhan Reynolds.

Kerlikowske Responds

Thursday, March 22nd, 2012

The drug czar himself has written a response to my HuffPost series on prescription painkillers.

Give him some credit here, for at least engaging a critic. His predecessor’s approach was to pretend his critics didn’t exist.

I’ll have a response to Kerlikowske’s response in a few days.

Painkillers: Part Three

Saturday, March 10th, 2012

The third part of my three-part series on the painkiller debate is now up at Huffington Post.

Check the comments for more stories from pain patients who have been unable to find treatment.

Morning Links

Thursday, March 8th, 2012
  • The latest edition of Cato Unbound looks to be pretty interesting. It’s on DNA testing and the death penalty.
  • Interesting look at the lobbyists who are paid to keep marijuana illegal.
  • Bunk opens a grocery.
  • So this is absurd. Let’s hope Texas doesn’t hear about it.
  • Doctor faces murder charges for prescriptions she wrote for painkillers. Note that the investigation began in 2008, the deaths she’s charged with causing occurred until December 2009, and she had her license and was still prescribing until at least the end of 2010. This is consistent with the criticism that law enforcement agents are more interested in bagging scalps and seizing assets than protecting patients.
  • Remember when media consolidation was the big fear? Now, it’s too much media. Where are you when we need you, Rupert Murdoch!?!
  • Recently laid-off manual laborer leaves a generous tip.

Morning Links

Tuesday, February 21st, 2012
  • British government, public health activists say alcoholism running rampant even though per capita consumption is down.
  • States looking to pass yet more policies to curb access to prescription drugs. Note that one politician quoted refers to “patients” trying to manipulate the system, not “addicts” or “dealers.” A patient trying to manipulate the system is a patient who can’t get the drugs he needs, because of the system.
  • I feel another law named after a dead person coming on.
  • Oakland cops were given body-mounted cameras to improve relations with the public. But they aren’t turning them on when they’re policing protests.
  • The best outcome to the birth control debate: Make the pill available over the counter. I have a feeling neither side would approve.
  • Philly cops say they aren’t required to observe bike lanes.
  • Middle-aged American Family Association columnist calls high school junior a “small-minded and vengeful brat.” He also calls her “mean.”

The New Painkiller Panic

Wednesday, February 8th, 2012

Part two of my three-part series for Huffington Post is now online.

It takes a skeptical look at the new overdose/abuse figures the federal government is touting, and points out that the problems we’re seeing today with pill mills and strip-mall clinics are the result of overly protective drug control policies. And they’re the same sorts of policies opioid critics are now saying need to be expanded and strengthened in response to the latest panic.

DEA Spots Fly, Wields Sledgehammer

Wednesday, February 8th, 2012

Just how much the federal government prioritize drug control over patient care? This much:

Federal authorities have expanded their crackdown on painkiller abuse, charging a major health care company and two CVS pharmacies in Florida with violating their licenses to sell powerful pain pills and other drugs.

The Drug Enforcement Administration linked Cardinal Health to unusually high shipments of the controlled drugs to four pharmacies.

On Friday, the DEA suspended Cardinal’s controlled substances license at its Lakeland, Fla., distribution center, which services 2,500 pharmacies in Florida, Georgia and South Carolina . . .

In its suspension order, the DEA alleges that Cardinal knew or should have known that the four retail pharmacies had purchased far more drugs than it needed to fulfill legitimate prescriptions.

The company called the DEA action a “drastic overreaction” that would disrupt delivery of critical medications to hospitals and pharmacies.

A judge has since temporarily stopped the suspension, pending a hearing.

But think about what the DEA is trying to do, here. They’re attempting to interrupt the treatment of thousands of patients served by 2,500 pharmacies because the wholesaler that supplies controlled drugs to those pharmacies is accused of inadequately policing the actions of four of those pharmacies. And the patients that would have been affected here aren’t just pain patients.

But the effect of actions like this going forward may be worse than the actions themselves. The DEA has forcibly deputized every actor in the manufacture and distribution of these drugs to police everyone else. And they risk severe civil, even criminal, repercussions if the agency determines they’ve done so with insufficient vigor. If you want to survive, you always err on the side of control.

So if you’re a wholesaler, and you have the tiniest of suspicions that a pharmacy is dispensing more of a controlled drug than the DEA thinks it should, you cut off supply, or you risk losing your license. If you’re a pharmacy, and you have the faintest hunch that a patient may not be legitimately in pain, or is getting more pain medication than he needs, or that a particular doctor is writing more prescriptions for a controlled drug than the DEA thinks he ought to, you refuse to fill the prescriptions, at risk of both losing your livelihood as a pharmacist, but also possibly your freedom. If you own a pharmacy, and you suspect one of your pharmacists is insufficiently suspicious of pain patients and pain prescriptions, you fire him, or you risk losing your business. And finally, if you’re a doctor, and you suspect any of your patients have a substance abuse problem, or that they aren’t in as much pain as they claim, you turn them down. Actually, it’s worse than that. It doesn’t really matter what you think as a doctor. What matters is what the DEA thinks of the decisions you make. So your job is not to administer the treatment you believe is appropriate, your job is to anticipate what treatment the DEA will think is appropriate, and deviate from that treatment at your peril.

At each step in the process, the incentives are structured to induce fear, suspicion, and mistrust of the other players in this mess. The interests of patients are way, way down in the ordering of priorities.

My Series on the Painkiller Panic

Monday, January 30th, 2012

This week at Huffington Post, I’ll be posting a three-part series on the latest outbreak of prescription painkiller panic.

The first part is up today.