Opioid regulation ignores the larger issues

Treating chronic pain: Regulation ignores the larger issues |Shirie Leng, MD | Meds | December 23, 2014

In 2009, the FDA asked for recommendations on restricting prescribing which were met with opposition from drug companies and physicians’ lobbying groups.

They are talking about pain patient advocacy organizations here, insinuating that they have nefarious motives, and that suffering patients are just lobbyists for pharmaceuticals or doctors (whichever is the punching bag in the particular article).

It’s a conundrum for pain patients because we happen to need what the pharmaceutical industry wants to sell, even while our goals and motives are not just different, but oppositional:  

  1. we want access to generic opioids at low prices to allow us some quality fo life  
  2. they want to create profitable new versions of opioids or other new drugs to increase their obscene profits

However, I do agree with the following statement:

Doctors cannot be responsible for what people put in their mouths.  

What is the problem here?  A few physicians violating the Hippocratic and every other oath I can think of?  

Oh, yes.  Doctors and pill mill owners should absolutely be prosecuted to the full extent of the law.

There were a handful of extremely obvious outlier cases causing 95% of the problem, but even after those were shut down, the authorities made a fuss over “cracking down” on everyone to deflect from the fact that they allowed these blatant pill mills to operate right under their noses.

This was a classic scenario where a few liars, cheaters, and scammers ruined compassionate pain management treatment for all of us.

But, as I pointed out above, addiction is an old disease.  Some of the Florida patients who can’t get prescription narcotics anymore will go to heroin or cocaine.  Some will get morphine instead.  Some will seek rehab treatment.

The larger issue, however, is addiction itself.  

The social, genetic, behavioral, and neurochemical drives for drug use are powerful, persistent, and ancient.  

We can choose to criminalize drug use, declare it a disease and treat it, ignore it, or feed it.  

What we do with it, as a society, will be one of the things that define us for future generations and civilizations

Author: Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.
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