On behalf of Free World Media and a client, I attended a DEA symposium today, "Good Medicine, Bad Behavior: The National Symposium on Pharmaceutical Diversion." DEA hosted this event to raise awareness for their expanding focus to prescription abuse, not just abuse of street drugs, as well as the opening of a museum on the history of the prescription abuse problem. Reading below about my experience of this symposium, you'll understand why I felt like Hunter Thompson in his book, "Fear and Loathing in Las Vegas" (1970), when he accidentally found himself in a sea of enforcers, at a DEA meeting.
Drug Czar John Walters welcomed everyone, saying the 7 million abusers of prescriptions is an 80% increase over 6 years, and that a problem is that partiers think these prescriptions are safer than street drugs. However, Walters admitted that opioid pain medicine can be a "godsend" to patients, and that only 1/5 of diversion stems from doctors, with 56% coming from family medicine cabinets (Actually, the DEA previously has admitted that a majority of diversion comes from post-manufacture deliveries to pharmacy warehouses).
Also, studies show addiction is vastly overrated as a problem - HHS says only 10% of pain patients run the risk of addiction; rather, such patients are like diabetics who are "dependent," not "addicted," to insulin. Likewise, pain patients are dependent, not addicted, to their opioids (like Oxycontin) for relief. 50 million americans - one in five - suffer excruciating, longterm pain with insufficient relief. The reason is simple - the involvement of law enforcement in the doctor-patient relationship; and the solution is simple - removal of law enforcement from the doctors' offices.
At the symposium DEA announced plans to expand its War on Prescriptions from the doctors offices to pharmacies, by urging Congress to prohibit cyber prescriptions without a face-to-face visit with a doctor (Later, DEA's Joe Rannasizzi admitted that closing one internet pharmacy just squeezes the balloon of demand to another internet pharmacy - he said, "check their chat rooms and see the referrals to new pharmacies!"). The demogoguery on internet medicine will only interfere in consumer convenience.
Later, when Joe complained 90% of opioid use occured in the U.S., another panelist, William Clark from SAHMSA, corrected him, saying that's because developing countries don't offer opioids. The New York Times ran front page stories a couple months ago showing Africans, writhing in pain for lack of opioid relief, commiting suicide for lack of relief. The government keeps no statistics on suicides from pain undertreatment - that's because all the Enforcement thugs and Addictionologists care about is addiction, and making sure Americans are fearful of it. There's a War going on, and facts will only get in the way.
The sole pain doctor, William Jacobs, sadly offered only a little sobriety in the discussion. He said high dose opioid treatment was just ten years old as a standard, but that failure to use such treatment now is considered malpractice. Five of the top Ten prescription killers are analgesics, he said, with "opioids having an abuse potential not shared by other prescriptions". Unfortunately, he failed to differentiate the purity of opiod prescriptions with the dangerous alternative drugs being pushed by Big Pharma - the so-called NSAIDS that bleed the gut and cause heart attacks (like Vioxx). The War on Opoiods, indeed, is a big aggravator of overprescribing. Get rid of the War on Drugs, and patients can limit their prescriptions to opioids, which are pure because they match the endorphins already produced in human nervous systems. (That's why the poppy plant has served as nature's pain relief for thousands of years going back to Egypt).
Interestingly, Dr. Jacobs said academics now were debating whether Congress should codify an "inalienable right to freedom from pain," but that Jacobs warned against striving for an unattainable goal. Showing what "side he's on," Jacobs said doctors who "break the rules," who miss "red flag behavior," are "not practicing medicine" and "should be held accountable." He said there's "big money in drug sales," and that doctors need a "CME continuing education in pain management," and "medical schools need more pain training." He said an unfunded federal prescription monitoring program called "NASPER" should get funding, to allow professionals to better track patient compliance with prescriptions. When asked by an LATimes reporter if the prescription abuse showed a need to scale back on opioids, Dr. Jacobs objected, saying he "needs more quivers for his bow," and that companies are constantly producing newer, better medicines. In other words, Dr. Jacobs is one of the scared, sneaky doctors, willing and ready to defend the state-of-the-art, that high dose opioids are the standard of care, but that doctors who follow this standard should suffer in prison if they fail to read the minds of patients who may later sell those drugs improperly. So doctors know longer can follow the Hippocratic Oath; instead, they are deputies in the War on Pain Medicine.
A nice thing said by another panelist, pharmacist Michael Mone, was that the category of "misusing drugs" should include "undertreatment." Also, he said pharmacy robberies (diversion) represent a "failure of addiction treatment," to treat these robbers - implying that treatment, not enforcement, is the solution to the diversion problem. Unfortunately, Mr. Mone was too subtle in his presentation to show that he understood the severity of the undertreatment epidemic and the role of Enforcement in creating the Chill in pain medicine.
C-Span covered the symposium, and I asked a couple questions that should show up when C-Span broadcasts it:
My first question, to Dr. Jacobs, was how a focus on 7 million mis-using partyers can compare to the 50 million patients suffering searing, long-term, undertreated pain, as ">reported in the New York Times, and why the Symposium had NO PATIENT REPRESENTATIVES, and would Dr. Jacobs describe the chill in pain medicine please? Jacobs agreed that "opioid phobia" was scaring not only doctors from prescribing, but also scaring patients from seeking.
And I asked the DEA Diversion Director, Joe Rannazzisi, how he felt about the State Attorneys General in 2005 condemning DEA for chilling pain medicine. Joe responded that "no one at DEA wants to see patients in pain," and that only 71 doctors last year were arrested by DEA, .001 of doctors registered to prescribe controlled drugs, and that these doctors are dealers, not doctors. Joe gave this figure last July, during the Crime Subcommittee hearing on the "DEA's Regulation of Medicine," but what he fails to admit is that the percentage of arrested doctors spikes to 17% when compared against doctors who actually specialize in pain relief.
A question I didn't get to ask was how DEA felt about the suffering veterans, and the wounded soldiers returning from Iraq, as per the statement by a Veterans Administration official who's worried about lack of opioid relief for those who fought for our country. Anyone who calls themselves pro-military has got to oppose the War on Drugs.
And not only are wounded veterans suffering because of the DEA's chill on pain medicine, but also the retiring Baby Boomers are in for a rude awakening as they grow old and increasingly in need of pain relief - you can't get high dose opioids any more! (All a patient can get these days is low dose opioids, alternative patentable NSAIDs that have horrible side effects, and unnecessary surgeries). Think of the suffering! This issue is about to explode.
It was disappointing to see a reporter from Wired ask a softball question how the prescription focus would change the Drug War, given that most computer geeks I know oppose the Drug War. How about a tougher question! It was awkward asking my brave question in a sea of Drug Warriors, so I had hoped for comraderie from the geeks! (Rannasizzi's anwer was "more investigations, not only of doctors, but also of pharmacies and the internet; and that he was hopeful Congress would update CSA to facilitate internet prosecutions.)
It was nice to see the Common Sense Drug Policy folks there, as well as MAPPS. The latter asked when DEA's Administrative Law Judge would stop interfering in the licensing of the University of Amherst's marijuana program for research. Joe said he couldn't interfere in an ongoing ALJ process.
For background, you have the Szalavitz piece from Reason. My client, the Pain Relief Network, submitted testimony at the July 25 Senate Judiciary Oxycontin Settlement hearing.
Siobhan Reynolds was an actual witness at the July 12 House Crime Subcommittee hearing, "DEA Regulation of Medicine," a hearing accurately described in this story.
Some experts are suggesting, as a solution to the problem of the pain undertreatment epidemic, a solidification of the exemption supposedly already in the Controlled Substances Act, for doctor prescribing of opioid pain relief. Because DoJ has used paid expert witnesses in multiple trials to regulate what constitutes proper prescribing, the current exemption has lost its effect. Thus, a clarification is needed.
Even without the authorization to interfere in the doctor-patient relationship, DEA still would retain its power to stop diversion of prescriptions between their manufacture and their delivery to pharmacies. And DEA still would retain its role in arresting nonphysician drug abusers. But if a doctor deals drugs instead of prescribing medicine, only the State Attorney General could prosecute the doctor. This bill would return the regulation of medicine to state medical boards. Hopefully someone in Congress will introduce this bill and all of us can access pain medicine should we need it.
Until then, God help us all with Symposia like I attended today.