A new opioid crisis: beware lest you get what you asked for

America’s new opioid crisis, Politico – By SARAH OWERMOHLE – Apr 2020

This story definitely falls into the category of “beware lest you get what you asked for”.

The DEA has restricted the production of opioids by 50% over the last four years without concern for their medical use. They seemed to believe that all opioids are the same, whether bought, cooked, and injected in the street or prescribed by a doctor.

In their opinion, there were “too many” legitimate opioids being manufactured, so they set out to curtail that by cutting production quotas.

They were successful. They got what they asked for, and now we don’t have enough medication during a crisis.  And people are still overdosing just like before, with illicit opioids. 

DEA to raise quotas of opioids for COVID-19 care

DEA takes additional steps to allow increased production of controlled substances used in COVID-19 care – April 07, 2020

The Drug Enforcement Administration (DEA) announced today that it is increasing Aggregate Production Quotas available to pharmaceutical manufacturers for the production of controlled substance medications that are in high demand due to the coronavirus (COVID-19) pandemic. 

With its chokehold on necessary medicine, the DEA is now endangering the very citizens they claim to be protecting. Their bungled “drug-war” has become a war on science, public health, and honest reporting.

This is a turnaround from just a week ago when the DEA claimed that supplies were “sufficient”: Opioid supply crunch for U.S. coronavirus patients

Opioid supply crunch for U.S. coronavirus patients

Exclusive: Opioid supply crunch for U.S. coronavirus patients prompts appeal to relax limits – Reuters – Dan Levine – April 2, 2020

U.S. doctors running out of narcotics needed for COVID-19 patients on ventilators are asking the federal government to raise production limits for drugmakers, according to a letter seen by Reuters, after national quotas had been tightened to address the opioid addiction crisis.

It’s becoming ever more clear that the DEA has become an unacceptable impediment to healthcare delivery. They have no business regulating the practice of medicine when their purpose is the enforcement of the latest prohibition against an essential medicine.

The U.S. government sets annual limits on how much tightly regulated narcotics can be produced by pharmaceutical companies, and then allocates portions to various manufacturers.  

Illegal drug classifications based on politics not science

Illegal drug classifications are based on politics not science – report | Global development | The Guardian –Karen McVeigh – @karenmcveigh – Jun 2019 

Illegal drugs including cocaine, heroin and cannabis should be reclassified to reflect a scientific assessment of harm, according to a report by the Global Commission on Drug Policy

The commission, which includes 14 former heads of states from countries such as Colombia, Mexico, Portugal and New Zealand, said the international classification system underpinning drug control is “biased and inconsistent”.

A “deep-lying imbalance” between controlling substances and allowing access for medicinal purposes had caused “collateral damage”, it said.  

Tackle the epidemic, not the opioids

Tackle the epidemic, not the opioids – Nature.com – Judith Feinberg – Sep 2019

This article is notable mainly for where it was published: in the respected journal, Nature, the “International Journal of Science”.

Since 2000, the US Congress has passed several bills to address this opioid epidemic. All of these efforts have specifically targeted opioids. And that is part of the problem.

Historically, substance misuse has come in waves, with a new drug supplanting the previous one: the ‘heroin chic’ of the 1990s followed the ‘crack babies’ of the 1980s.

Opioids allocated based on business decision

‘Business decision’: Former DEA official works for opioid lawyers but set standards for how many pills were made – By John O’Brien | Sep 3, 2019

The DEA knew more about what quantities of opioids went where than anyone else, so I’m baffled why they didn’t stop the excessive orders that everyone is complaining about now.

Asked what would’ve happened if a pharmaceutical distributor wanted advice on whether a large order of opioids was suspicious, the man in charge of federal regulation of those pills for 10 years said he wouldn’t have helped.

Instead, Joe Rannazzisi, who set always-increasing opioid quotas for theindustry while he headed a Drug Enforcement Agency department from 2005-15, said the company would be left on its own to figure it out.   

Opinion | Fear, Loathing and Fentanyl Exposure

Opinion | Fear, Loathing and Fentanyl Exposure – https://www.nytimes.com/ By The Editorial Board – April 4, 2019

The New York Times has published many articles about the “opioid crisis” that follow the usual unchecked assumptions around opioids, so I’m glad this opinion piece by the “top guns” of the Times finally explains the problems posed by fentanyl: it’s super potent, but not by accidental skin exposure or “breathing fumes”.

As baseless public health scares go, the one about police officers and nurses purportedly overdosing from passive fentanyl exposure should have been easy to dispel.

Emergency workers across the country have reported dozens of such incidents in recent years, but their symptoms are often inconsistent with opioid poisoning.   

Ending DOJ’s Indiscriminate Raids

A More Sensible Surge: Ending DOJ’s Indiscriminate Raids of Healthcare Providers – by Michael C. Barnes DCBA Law & Policy, mbarnes@dcbalaw.com

This is a “Legislation & Policy Brief” I found that echoes what we’ve been trying to explain. This brief specifically mentions well-known doctors that have been prosecuted (and persecuted) by federal law enforcement for simply doing their jobs: treating their patients’ pain with opioids when nothing else gave relief.

Mr. Barnes understands and agrees with our position, urging that federal raids of doctors’ offices be halted.

He also points out that the overdose crisis is not about opioids specifically, that the deaths are from increasing numbers of people ingesting various combinations of illicit drugs. 

Most heroin addicts didn’t start with Rx pain pills

The White House drug czar is wrong: Most heroin addicts didn’t start with prescribed pain pills – Written by Phillip Smith / Independent Media Institute – July 2019

As part of its campaign to stem opioid addiction and overdoses, the White House Office of National Drug Control Policy (ONDCP — the drug czar’s office) has launched an education campaign called The Truth About Opioids, but some of the material it is presenting has more than a whiff of spin to it — and could imperil the ability of pain patients to get the relief they need.

I’m furious that they call it “the Truth” when it only spreads the big lie about the overdose crisis being from prescribed pain medications.

The website declares in big, bold letters that “80% of heroin users started with a prescription painkiller,” [NOT!] and highlights the words “80%,” “heroin,” “started,” and “prescription” in lurid purple.   

NarxCare score does not predict adverse outcomes

NarxCare narcotics score does not predict adverse outcomes – Reviewed by Kate Anderton, B.Sc. (Editor) – Jul 2019

The increasingly used NarxCare narcotics score does not predict adverse outcomes or patient dissatisfaction after elective spine surgery,

An opioid use score based on state prescription databases does not predict complications or other adverse outcomes in patients undergoing spinal surgery, reports a study in the journal Spine.

They write, 

“the current study did not identify perioperative outcome/satisfaction differences based on preoperative narcotics use criteria.”