This truly seems to be happening. Until now, the “practice of medicine” was carefully defined and defended by the AMA and anybody who tried to step between doctors and their patients was hauled into court.
This time around, the AMA has been noticeable mainly by their silence in the face of this assault on the integrity of medicine, when politicians and law enforcement agencies are controlling what kind of medical care doctors are “allowed” to provide their patients.
After a few brave individual doctors had been pushing back for years, and when the CDC and FDA were close to issuing their own statements warning against the abandonment and forced tapers imposed on patients, only then did the AMA finally release its own statement advising against such barbaric (and virtually illegal, in the case of patient abandonment) practices.
And after that single action, the previously respected AMA has again remained silent. It seems clear they don’t want to “rock the boat” too much and jeopardize their share of the vast amounts we spend on inferior healthcare in this country.
Their lack of action on behalf of suffering patients (and doctors too) shows that they’re concerned only with maintaining the status quo, which supports the high pay of doctors whom they “allow” to do the almost sacred “practice of medicine”.
The Drug Enforcement Administration, having virtually eliminated the diversion of prescription pain relievers into the underground market for nonmedical users, appears to be setting its sights on regulating the medical management of pain, a mission not suited for law enforcement.
the DEA announced a proposal to reduce, once again, the national production quotas for fentanyl, morphine, hydromorphone (Dilaudid), oxycodone, and oxymorphone, bringing the production levels down 53 percent from 2016 levels.
The ostensible purpose of the production quotas is to reduce the amount of prescription opioids that get diverted into the underground market.
As has been clearly demonstrated, the overdose rate from the nonmedical use of licit and illicit drugs has been on a steady, exponential increase since at least the late 1970s, with the only variation being the particular drug in prominence at any given period
Concerted efforts by policymakers to reduce opioid production and prescribing led to a 58 percent reduction in per capita high-dose opioid prescription volume from 2008 to 2017 while total opioid prescription volume dropped 29 percent from 2010 to 2017.
Despite these reductions, the overdose rate continued to surge.
Overdose deaths soared while prescription volume dropped as nonmedical users migrated to cheaper and more readily available heroin and now fentanyl
The share of opioid-related deaths involving fentanyl rose from 14 percent in 2010 to 60 percent in 2017. Based on data from the Centers for Disease Control and Prevention, fentanyl or heroin was involved in 75 percent of opioid-related deaths in 2017.
fewer than 10 percent of opioid-related deaths involved prescription opioids without those other dangerous substances.
With the DEA telling us that less than 1 percent of prescription opioids are currently diverted into the black market, why is it necessary for the DEA to tighten quotas even further?
In the recovery community, it’s common to define insanity as “doing the same thing over and over again and expecting different results”. This is meant to refer to people who turn to drugs over and over again and then seem surprised that their lives keep getting worse.
But now the DEA is doing exactly that: reducing the supply of legitimate opioids and arbitrarily restricting the amounts doctors are allowed to provide “over and over again” and expecting overdoses to decrease. Despite never having worked before, they do it again and again, expecting different results.
This only proves again the unpleasant truth: what we accuse others of always turns out to be a shadow of our own flaws.
Aside from the apparent desire of law enforcement to regulate the practice of medicine, there can be no justification for the continued reduction in opioid manufacturing
According to data from the CDC and the National Survey on Drug Use and Health there is no correlation between prescription volume per capita and “past month nonmedical use of prescription pain reliever” or “pain reliever use disorder in the past year” among persons aged 12 or above.
The NSDUH repeatedly reports that less than 25 percent of nonmedical users of prescription opioids get them through a doctor—most get them from a friend, relative or dealer.
And a classic study in 2007 that examined OxyContin addicts admitted to rehab between 2001 and 2004 found 78 percent claimed the drug had never been prescribed for them, and 92 percent used OxyContin in conjunction with multiple other drugs—cocaine being the drug 66 percent of the time. Also notable is that 78 percent reported previous treatment for substance use disorder.
The continued clampdown by the DEA also shows a complete lack of understanding about the nature of addiction. Addiction is a disorder characterized by compulsive use despite negative consequences.
And this is exactly why punishment does not work. People with addiction absorb all kinds of punishment for their addiction in the form of horrendous hangovers, excruciating withdrawals, ill health, and financial problems.
Why would any other punishment have an effect when it’s precisely the immunity to negative consequences that defines addiction?
Addiction is not the same as physical dependence.
As Drs. Nora Volkow and Thomas McLellan of the National Institute on Drug Abuse have pointed out, addiction to opioids is very uncommon, “even among those with preexisting vulnerabilities.”
Highly rigorous and respected Cochrane systematic studies in 2010 and 2012 of chronic pain patients found addiction rates in the 1 percent range, and a report on over 568,000 patients in the Aetna database who were prescribed opioids for acute postoperative pain between 2008 and 2016 found a total “misuse” rate of 0.6 percent.
Despite the voluminous evidence increasing all the time, it seems there is just no way to educate the anti-opioid zealots and their drug war buddies. They persist in believing that opioid addiction is completely different from any other form of addiction, a problem that humans have struggled with since the beginning of their time on this planet.
The DEA is tasked with the impossible assignment of determining just how many opioids, of all types, are needed to treat pain or provide anesthesia to roughly 325 million Americans in any given year, and to apportion specific production quotas to individual manufacturers.
As the central planners of the former Soviet Union—and the countless Russians who stood in long queues to buy necessities—would attest, it is impossible to plan how much of any product consumers need in a given year, let alone predict needs in the future.
The management of acute and chronic pain—as well as substance use disorder—is not in law enforcement’s wheelhouse. If relaxing the quotas is not in the cards politically, then the least the DEA can do is to stop making matters worse.
The DEA has always made opioid addiction rates higher. By removing controlled and carefully dosed medications from the market, they have forced people who are addicted and even pain patients into the arms of drug dealers.
And that is exactly where the DEA will not go, because they are cowards, preferring to the stage raids on peaceful, documented, and unarmed medical offices instead.￼