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Townhall...
Drug Control vs. Pain
Control: A Crackdown on Opioid Prescriptions Will Hurt Patients
By Jacob Sullum
Last week, unveiling a plan to curtail “diversion” of opioid
painkillers, Obama administration officials said they aim to “strike a
balance between our desire to minimize abuse of prescription drugs and
the need to ensure access for their legitimate use.” This balance will
never be achieved because the two goals are fundamentally
irreconcilable.
Since pain cannot be verified objectively, there is only so much a
conscientious doctor can do to make sure a patient is not a malingerer,
an addict or a drug dealer. At a certain point, he has to choose
between trusting his patients and helping the government enforce its
arbitrary dictates regarding psychoactive chemicals. If he sides with
his patients, he risks his license, his livelihood and his liberty. If
he sides with the government, it is inevitable that some patients will
suffer needlessly.
Doctors are less inclined to prescribe opioids, even to legitimate
patients in horrible pain, when they worry that regulators, police and
federal drug agents are looking over their shoulders, ready to
second-guess every decision and transform honest mistakes or medical
disagreements into felonies. Every additional layer of scrutiny only
compounds the drug war’s chilling effect on pain treatment.
That is one of the problems with the computerized prescription drug
monitoring programs (PDMPs) that the Obama administration wants every
state to establish. The benefits of such programs, which 35 states have
implemented so far, are questionable. A recent study by researchers at
the U.S. Centers for Disease Control and Prevention found that “PDMP
states did not do any better than non-PDMP states in controlling the
rise in drug overdose mortality from 1999 to 2005.”
To the extent that PDMPs do succeed in changing doctors’ prescribing
practices, the impact won’t be limited to nonmedical users. Data from
the National Survey on Drug Use and Health indicate that 70 percent of
nonmedical users get painkillers from friends or relatives with
prescriptions. Cutting off these sources through aggressive monitoring
is bound to hurt many legitimate patients.
The same thing is true of the Obama administration’s proposed
requirement that doctors be barred from prescribing narcotic
painkillers until they receive “training on the importance of
appropriate prescribing and dispensing of opioids to prevent adverse
effects, diversion and addiction.” First, the training mandate (which
would require new legislation) would reduce legitimate patients’ access
to painkillers by reducing the number of physicians authorized to
prescribe them. Second, the focus of the training would tend to make
doctors even more suspicious of patients seeking pain treatment.
To justify a crackdown that will be effective only if it hurts people
in pain, the Office of National Drug Control Policy says we are
experiencing a “prescription drug abuse crisis” that amounts to an
“epidemic.”
Although there is little evidence of such an epidemic in the federal
government’s own survey data, the number of fatal overdoses involving
opioid analgesics nearly quadrupled between 1999 and 2007. Meanwhile,
the amount of opioids prescribed per person has increased by an even
larger percentage, meaning the risk of overdose is smaller today than
it was a decade ago.
These overdose deaths mainly result from careless decisions by
nonmedical users who either take too much or mix narcotic painkillers
with other depressants. All the talk of an “epidemic,” which brings to
mind a deadly microbe that infects people who have no choice in the
matter, tends to conceal this reality. The New York Times says
OxyContin “hurtled through” an Ohio town, as if it were a tornado
indiscriminately wreaking havoc instead of a drug deliberately taken by
people who like its psychoactive effects.
By contrast, people who suffer from severe chronic pain as a result of
car crashes, botched surgeries or degenerative conditions do not choose
to be in that situation. It’s bad enough that they are forced to beg
government-appointed gatekeepers for relief. They should not be
punished further because of other people’s reckless choices.
Read it at Townhall
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