How Serving Pain Patients Is Made To Look Criminal
America's war on pain pills is a war on people in pain.
Jacob Sullum gives an example at Reason of how a minor mistake on a patient's part led to his continuing -- and unnecessary -- suffering with pain opioids used to alleviate:
After struggling with herniated discs and neuropathy, Craig consulted with "about 10 different surgeons" and decided to have his bottom three vertebrae fused. He continued to suffer from severe lower back pain, which he successfully treated for years with OxyContin, a timed-release version of the opioid analgesic oxycodone. He would take a 30-milligram OxyContin tablet twice a day, supplemented by immediate-release oxycodone for breakthrough pain when he needed it.Then one day last May, Craig's pain clinic called him in for a pill count, a precaution designed to detect abuse of narcotics or diversion to nonpatients. The count was off by a week's worth of pills because Craig had just returned from a business trip and forgot that he had packed some medication in his briefcase. He tried to explain the discrepancy and offered to bring in the missing pills, to no avail. Because the pill count came up short, Craig's doctor would no longer prescribe opioids for him, and neither would any other pain specialist in town.
"I have lived my life by the rules," says Craig (whose name I've changed at his request). "I made one mistake, and they condemned me for it. They were basically saying that I'm a druggie when I have been fine for four years. My first pill count ever, and they boot me." He says a nurse at the practice told him "the doctors were getting tired of all the scrutiny, so they were booting all the opioid patients."
Without the OxyContin, Craig says, "every morning is a challenge to get out of bed." Even with liberal use of ice packs and Biofreeze, he says, "It's horrible. I can't expect to live a life like this. I'm not a junkie. I'm not a threat to society. I'm not a threat to myself. I simply want to live my life without pain."
Like other patients across the country, Craig is a victim of the recent crackdown on prescription opioids, which is based on a narrative that mistakenly blames pain treatment for a plague of addiction and death. Most Americans believe we are in the midst of an "opioid crisis" that began in the 1990s with the introduction of OxyContin. According to the generally accepted account, deceptive marketing encouraged reckless prescribing, which led to widespread addiction among patients and record numbers of opioid-related fatalities--a situation President Donald Trump has declared a public health emergency.
Ira Stoll writes at Smarter Times about how doctors are made out to be criminals for serving their patients, and not just by the cops but by journalists -- journalists who lack meaningful evidence of any crime:
From a Metro section news article about federal criminal charges against doctors prescribing painkillers comes an example of how reporters collaborate with prosecutors to cast accused criminals in the most negative possible light: "Dr. Pietropinto, the psychiatrist who saw people at night in a rented office on Fifth Avenue, wrote thousands of prescriptions for large amounts of oxycodone in exchange for $50 to $100 in cash per visit, the complaint said."It's highly common for doctors to rent offices rather than own them. It's also highly common for mental health professionals to have some office hours in the evenings so that patients who work or go to school during the daytime are able to see a doctor without missing school or work. There's nothing criminal or nefarious about a psychiatrist seeing people at night in a rented office. Yet the way the article is written, it makes it sound as if renting an office and having evening hours is somehow proof that the doctor is a shady or fly-by-night operator or guilty of a crime.
I'm not defending the doctors -- the opioid epidemic is horrible, and going after some doctors for over-prescribing for no legitimate medical reason, if that is indeed what happened here, is a welcome corrective to the error of blaming the whole thing on the Sackler family or on one pharmaceutical company. But if the Times or prosecutors want to demonstrate that the doctors are guilty of a crime, they need to demonstrate that, rather than merely attacking them for doing perfectly legal things, such as renting an office or having evening hours.
In the same category is the article's treatment of the use of cash money. Many modern health insurance policies -- including those available under the ObamaCare exchanges that the Times so ardently editorially advocates -- feature substantial patient financial responsibility for deductibles, co-pays, and co-insurance. It is not a crime to pay those fees in cash rather than by check or credit card. It may help doctors keep fees lower by avoiding credit-card processing charged by banks. Some patients -- the "unbanked," either because of poor credit or illegal immigrant status -- may not have credit cards or checking accounts, but may have access to cash. There's a push by the government against cash transactions because they are more difficult for the government to track, but there's no reason for the Times news reporters to cooperate with that.
The fact that some misuse opioids should not be reason to deny them to those who need them -- any more than the fact that some people are alcoholics should be reason to deny the rest of us beer, wine, or liquor.
Stoll via @Overlawyered
A doctor renting office space is probably more common than a doctor owning office space. Doctors keeping hours in the evening isn't uncommon either. A doctor with an independent practice accepting cash doesn't surprise me either. For doctors, getting paid can be difficult and expensive. When I've been without insurance I've offered doctors with independent practices cash in exchange for nice discounts. Psychiatrists can have a hard time getting paid because their patients have mental illnesses that are often disabling and keep them from working, having insurance, having checking accounts and having money. I wonder, though, why a psychiatrist would need to prescribe a lot of oxycodone.
The overuse of opiod pain meds seems to be more of a symptom of a problem. Maybe the symptom would go away if the president declared the inadequate treatment of conditions that cause pain to be a public health emergency.
Ken R at October 26, 2018 10:30 PM
I loved what you had to say Ken.
PS. I think the causes of pain can be both mental and physical. I read that during wars, particularly the Vietnam war, most of the men were constantly high. It might be speed, herion, or LSD. Even pilots in the World Wars used speed. When those men came back, few struggled with addiction. Those those had a place in society stopped they drug use with ease.
In an experiment, rats were given unlimited cocaine water and put in rat paradise with just the right amount of company and stimulating activities. The rats left the cocaine water alone. As they let the population grow until the rats were miserable, cocaine use increased. Some rats started sucking on the water all day. I couldn’t find the study now but it made me think about our treatment for addiction.
I truly fear something happening to me where I have a lot of pain. I would rather not have to use opioids, but if I ever need them, it would be life-saving to have them available.
Jen at October 27, 2018 5:25 AM
I have no doubt that substance abuse is related to people feeling lost and without a place in society. But I have quite a bit of arthritis pain and over the counter stuff is barely controlling it. I'm pretty scared what to do if it gets worse.
The idea that people in pain are criminals is insane. Pain can be debilitating.
cc at October 27, 2018 8:29 AM
"The fact that some misuse opioids should not be reason to deny them to those who need them -- any more than the fact that some people are alcoholics should be reason to deny the rest of us beer, wine, or liquor."
But for those inclined to be prohibitionists-- and that's almost everyone who isn't libertatian-- that's exactly the only reason they need. Control freaks lust to control.
Kent at October 27, 2018 8:38 AM
@Jen,
The experiment's name is Rat Park. There's a Wikipedia entry about it, but I'm not skipping the opportunity of posting a comic strip about rats.
http://www.stuartmcmillen.com/comic/rat-park/#page-1
Sixclaws at October 27, 2018 1:34 PM
There's also an animated short about Rat Park which is more social media friendly:
https://www.youtube.com/watch?v=ao8L-0nSYzg
Sixclaws at October 27, 2018 1:35 PM
I literally just got a disparing text from a friend as I read this post. She has permanent nerve damage from compressed neck vertebrae and now her lower back vertebrae are undergoing the same deterioration so the pain and numbness are also in her legs. She is a nurse, now on disability, who has never abused her health or her medications. She's also tried absolutely every therapy and treatment besides opioids and only opioids really help. Her doctor wants to reduce her pain meds and honestly if that results in even more pain than she has, I don't know how she will survive. It's criminal to treat pain patients and their doctors as criminals. I am super-compassionate but I'd trade any number of addicts in exchange for preventing agony for those in untreatable pain.
RigelDog at October 27, 2018 1:46 PM
Open access by adults to painkillers ought to be recognized as a human right, and they ought to be available over-the-counter everywhere.
Until that happens I would like to see someone publish a recipe for making your own, if it can be done safely. Let's solve this problem technically in a way that no amount of law enforcement can stop.
anon1859 at October 27, 2018 10:15 PM
" Let's solve this problem technically in a way that no amount of law enforcement can stop."
As if you want your property to be stolen to fund some addict.
If you look at the patient records portion of this proposal, you'll see a way to fix this issue.
Except you'll still have people so miserable they buy Fentanyl, Hydrocodone etc. because getting high is all they desire. Note the salient public role methamphetamine plays?
You mentioned rights - those are wholly arbitrary, and this idea of yours calls for unnamed others to subsidize drug distribution; even a person with intractable pain has no right to demand relief from me, under the color of law, welfare or otherwise.
I desire to set up a system where those in need can get what they must, but the approach you suggest will simply fuel the addiction of people seeking entertainment, and you know it.
Failure to change the law first has led to the massive criminal enterprises giggling potheads now dismiss with an airy wave - as they fund them.
Crime is the ultimate selfish act, and drug use, with the pathological lying needed to protect it, has no regard whatever for you or your rights.
Radwaste at October 28, 2018 8:38 PM
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