http://www.thedailybeast.com/articles/2016/04/15/feds-pill-crackdown-drives-pain-patients-to-heroin.html
The Centers for Disease Control and Prevention issued a broad set of recommendations in March for physicians and treatment facilities that dispense opiate medications. The same week Massachusetts Gov. Charlie Baker signed into law some of the most restrictive regulations ever governing the therapeutic use of narcotic drugs—including limiting first-time prescriptions for opioid pain medication to seven days worth of pills. At least six states have passed similar measures restricting the amount and potency of narcotic medications doctors can prescribe…
[Christopher] Baltz was in his third year of treatment for chronic pain resulting from a severe motorcycle accident and was being prescribed a high dose of oxycodone when Florida Gov. Rick Scott declared war on the state’s robust pain management industry in 2011…
Scott’s crackdown led to the closure of some 400 pain management clinics almost overnight, while a coordinated effort by the Drug Enforcement Administration targeted pharmacies suspected of over-dispensing controlled substances.
This took the form of more aggressive enforcement of a decades-old federal mandate known as “corresponding responsibility” that holds pharmacies legally accountable for ensuring the drugs they dispense are being used for a “legitimate medical purpose.”
In theory, the policy is designed to add another check in the process of preventing drug abuse and diversion. In practice, it places pharmacists in the unwarranted position of policing doctors, and discriminating against patients on the basis of often arbitrary red flags (for instance, paying for their prescriptions in cash).
The net effect of the crackdown in Florida was profound and acute. Prescription drug deaths dropped precipitously within the first year-—but heroin deaths rose 39 percent, as patients cut off from legal opioids turned to illegal drugs for relief…
In spring 2013—two days after receiving a courtesy call confirming his monthly appointment—Baltz showed up at his pain management clinic only to find it had been closed down. Within weeks he was making regular trips to Miami to buy heroin.
“The government wants to prevent people abusing pain medication, but there’s no exit strategy,” said Baltz. “I never even saw heroin until this happened.” …
According to the United Nations, 5.5 billion people around the world already suffer from inadequate pain treatment. This includes roughly a third of all cancer patients in the U.S.
Dr. Webster is one of hundreds of doctors and pharmacies that have been investigated by the DEA since it launched its OxyContin Action Plan in 2001. The plan signaled a shift in federal enforcement tactics away from a focus on illicit street drugs and toward preventing controlled pharmaceuticals from falling into the wrong hands. Over the next 13 years the DEA added more than 1,500 personnel and more than doubled its budget. It also significantly ramped up administrative audits of registrants authorized to dispense controlled substances. (As The Daily Beast reported last year, over the same period the DEA was increasing its quotas of Schedule II pharmaceuticals approved for commercial sale).
During one year alone (2009-2010) the number of regulatory investigations conducted by the DEA’s Office of Diversion Control (responsible for policing prescription drugs) more than tripled, according to the Government Accountability Office…
Federal law requires that all prescriptions for controlled substances be for a “legitimate medical purpose,” but it doesn’t define the term…
Ironically, there is evidence that restricting patient access to pain medicine could actually lead to more overdoses, not fewer. Medical examiners are already unsure of how many deaths attributed to “unintentional overdose” are actually suicides. Chronic pain patients frequently suffer from ancillary mental health problems—including depression, anxiety and insomnia—and are at least twice as likely to commit suicide.
In 2013, when the Department of Veterans Affairs responded to a runaway painkiller problem with a new Opioid Safety Initiative, reports surfaced of patients being cut off their medication without proper dose reductions. Within months the agency came under fire for its new policy when a 52-year-old Navy veteran shot himself in the head in front of an outpatient clinic in Virginia after he was forced off his pain meds.
“The medications were the only thing that was helping him, and when they took that away from him, his life just went downhill,” a friend of the dead man told a local paper…
Meanwhile, there is evidence that the majority of prescription opioids that are diverted for illicit use come from the acute care setting, not the treatment of chronic pain.
I’m not sure that makes sense, if this is also true:
From the New York Times: “And so although emergency physicians write not quite 5 percent of opioid prescriptions, E.R.s have been identified as a starting point on a patient’s path to opioid and even heroin addiction…”
But perhaps it just shows how small the diversion problem really is, even though we’ve spent so much money (and ruined so many lives) in the effort to combat it.
Dr. Daniel del Portal, who teaches emergency medicine at Temple University’s Lewis Katz School of Medicine, says the modern health care system often incentivizes doctors in acute care settings to find a quick fix for patient complaints. “The pressure is on physicians to make patients happy at any costs,” he told The Daily Beast…
Really? How many doctors have you known that made an effort to make you happy? I don’t ever recall feeling happy after leaving the doctor’s office.
Finally, doctors say there is little use in recommending alternative treatments for patients if they can’t afford them. Pain pills are cheap, and usually fully covered by insurance; physical therapy, chiropractic care, and yoga are expensive, and almost always include co-pays (if they are covered at all)…
Sure, the only reason pain patients don’t use alternative treatments is because of the cost. That really flies in the face of how many pain patients pay out-of-pocket for these alternative treatments, as many are forced to do before they are even given access to opioids.
The fact is that alternative treatments have not proven to be very successful, and their gains are extremely short-lived. This is about treating constant, daily pain, not an injury that will improve over time. For instance, I’m sure there are plenty of pain patients who would welcome a daily massage (if they could afford it), but I would need painkillers before I agreed to let someone work on my body. It would be a treatment that caused more pain, just like so many others I’ve tried. Seems to me that most of the treatments which cause more pain don’t provide as much benefit as their practitioners would have you believe. “No pain, no gain” doesn’t really work when we’re talking about chronic pain.
Another problem is that many of these alternative treatments can be practiced at home, but unless you’re being seen by a doctor, disability insurance companies will question if you’re really suffering from chronic pain. And what’s the point of paying for a doctor if all she can prescribe are these alternative treatments? Because you really don’t need a prescription for yoga, meditation, stretching and exercise, and many other alternative treatments. (Doctors suck.)
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