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March 20, 2014

"Drug Dealers Aren't to Blame for the Heroin Boom. Doctors Are."

The title of this post is the provocative headline of this interesting new article from The New Republic. Here is a portion of how the piece gets started:

Heroin epidemics don’t come and go randomly, like the McRib. They have clearly identifiable causes — and in this case, by far the largest cause is doctor -prescribed pills. Every year since 2007, doctors have written more than 200 million prescriptions for opioid painkillers. (Consider that there are 240 million adults in the country.)  And about four in five new heroin addicts report that they got addicted to prescription pills before they ever took heroin....

Most people who try opiates don’t get addicted.  But enough do. Since 2002, the total number of monthly heroin abusers has doubled to 335,000 nationwide.  Some of the addicts get the pills through a well-meaning doctor or dentist, and many others swipe leftover pills from their friends or family members.  The result for an addict is the same: Once the pills or money run out, heroin is still available — and cheap.  At about $10 per hit, it can be half the street cost of pills.

“We seeded the population with opiates,” says Robert DuPont, an addiction doctor who served as drug czar under Presidents Nixon and Ford and who is now a harsh critic of opiate over-prescription.  The supply shock from easy access to prescription drugs has pushed heroin use out of cities and into rural and suburban and middle-class areas. Massachusetts reported a staggering 185 heroin deaths outside its major cities since November, and Peter Shumlin, the governor of Vermont, spent his entire “state-of-the-state” address talking about the nearly eightfold increase in people seeking opiate treatment there since 2000.  “What started as an OxyContin and prescription-drug addiction problem in Vermont has now grown into a full-blown heroin crisis,” he said.

In addition to providing an important reminder about the dynamic (and sometimes unpredictable) intersection of medical care, drug abuse and the "war on drugs," this piece also suggests a reason why we might not want to readily assume (or trust) that the medical profession will be an effective and healthy intermediary when debating how best to reform marijuana laws and regulate the use of cannabis-based products as a pain relievers.

March 20, 2014 at 02:56 PM | Permalink

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Comments

Fifty years ago the television, CBS News included, was paid by the tobacco industry to convince you schmucks to smoke. When Walter Cronkite wrote his autobiography he told the story of how he got reprimanded for correcting an improper English sentence. "Winston tastes good, AS a cigarette should." He said Noooo. Its "like" a cigarette should. Ed Murrow was the same. Smoked on the air, did the commercial for Winston right in the middle of the news cast. Now its: "Ask your doctor". Same thing. Different strokes for different folks. Don't go to a doctor who prescribes drugs. How do you know which ones do? Ask your pharmacist.

Posted by: Liberty1stl | Mar 20, 2014 3:16:36 PM

"why we might not want to readily assume (or trust) that the medical profession"

So I'm going to assume that in true libertarian fashion you think /no one/ should be trusted? If not doctors, who?

Posted by: Daniel | Mar 20, 2014 5:46:22 PM

I think citizens having a healthy suspicion about why and how other citizens (and/or institutions) reach and advocate positions/policies is essential to a well-functioning democracy, Daniel. Trust can be earned, but it can also be lost. The medical profession has a mixed record --- like most modern institutions --- but this story highlights how we should "follow the money" and ask hard questions about whether health concerns or economics drives various ways in which opioid painkillers get distributed in the US.

Returning to the issue of marijuana, I often wonder if concerns about marijuana being used for pain relief coming from the medical profession sometimes can be influenced by the fact that the medical/Pharma industry now makes a whole lot of money (and gets a whole lot of power) by having a monopoly on authorization for certain meds for pain relief.

Posted by: Doug B. | Mar 20, 2014 6:02:33 PM

The overwhelming majority of opiate abusers (77%) get their supply from people they know, and not from doctors.

Again, thank the lawyer. Doctors under treating pain had to pay $1.5 million to settle tort claims. The lawyer thug persuaded the jury to not call it malpractice. It was called elder abuse, a crime under California law. Then lawyer thugs on medical licensing boards, self-styled prosecutors, hounded and persecuted doctors for the same. Then the feds went after the docs for insurance claim fraud, for their under treatment.

The doctor was lucky if he collected $50 for his service in the nursing home.

I believe doctors should be the spear point of the return of fire by all productive sectors against the criminal cult enterprise besieging our nation. It should begin with a boycott of all tort litigators, and of all tort plaintiff low lifes. Put them on no service lists, and let them die in agony. Plumbers, stores, and all other product and service providers should do the same. Shun the internal enemy. To deter.

Posted by: Supremacy Claus | Mar 20, 2014 8:32:32 PM

Lib: Try to not age. Past 30, an organ will fail every 5 years. Put yourself on the shun list. And treat your afflictions by prayer.

Posted by: Supremacy Claus | Mar 20, 2014 8:35:28 PM

"The medical profession has a mixed record --- like most modern institutions..."

Oh, yea? Perhaps you are correct. With 116 million chronic pain patients, say a million become hopeless addicts due to the mismanagement of doctors, and that hundreds of them die. The error rates remain at the margins. The number over treated and under treated are 1 or 2%. One should still strive to stop those errors.

Compare to the criminal law. 90% of FBI Index felonies go unanswered, wiht 20 million serious crimes, not including drug dealing, and 2 million prosecutions a year. When they have a guy, in 10 to 20% of cases they got the wrong guy, and in a quarter of those false positives, the lawyer dumbass implanted false memories in the innocent defendant and persuaded him to confess.

Posted by: Supremacy Claus | Mar 20, 2014 8:48:09 PM

"Returning to the issue of marijuana, I often wonder if concerns about marijuana being used for pain relief coming from the medical profession sometimes can be influenced by the fact that the medical/Pharma industry now makes a whole lot of money (and gets a whole lot of power) by having a monopoly on authorization for certain meds for pain relief."

This is just ridiculous. First, is there any scientific evidence that marijuana has strong analgesic properties? Second, most doctors view the prescribing of opioid drugs as a burden not a financial boon.

Posted by: JJ | Mar 20, 2014 9:07:07 PM

SC: You say the US has 116 million chronic pain patients. According to Google (I know it can't be trusted) we have 314 million persons in the US. This means over 1/3 of our population is in chronic pain and needs drugs. Assuming these numbers are true is there any data on how many malingerers are among the 116 million chronic pain patients?

Posted by: ? | Mar 20, 2014 9:22:14 PM

?

The ACA mandated a review of chronic pain, due to its costing $635 billion. The Institute of Medicine wrote this:

http://www.ncbi.nlm.nih.gov/books/NBK92525/

Doctors demand objective evidence of disease, scans, blood work, imaging of hot areas on the body, whatever. They are being criticized by the experts. These would like to make pain whatever the patient calls pain.

They are being intimidated by the lawyer from 2 directions. The DEA wants to lock them up as drug pushers. The licensing board and plaintiff lawyers want to sue them for elder abuse for under prescribing. The best course is to say, fuck the lawyer, and just use clinical judgement. I would add, destroy the life of the lawyer enemy coming around. Give no quarter to this heartless enemy. Start with all out e-discovery, counter-suits, injunctions, demonization in the press with a patient in agony in tow. It should progress to a campaign of personal boycotts, where the lawyer enemy gets excluded from medical care. Then violence against lawyers and judges has full justification in formal logic, in the law of necessity, and in plain policy correctness. To deter.

There is a phenomenon called pseudo-addiction. A genuine pain patient acts like a hustling, nagging, pressuring addict to get "more drugs." However, upon reaching the correct doses and schedule providing adequate pain control, all negative behavior stops. Even terminal patients want to return to their lives, and do what they always did. Ordinary activities take on a deliciousness and a thrilling quality after pain has been controlled.

http://www.ncbi.nlm.nih.gov/pubmed/2710565

Think of it as the opposite of malingering, with real pain driving the desperation of the patient.

Posted by: Supremacy Claus | Mar 20, 2014 11:58:43 PM

It's somewhat off-topic but that's an interesting case Mr. Claus. We often focus on how addiction warps behavior but forget sometimes that the lack of proper treatment can also warp behavior. This is especially true because some people buy into a cultural trope that admitting to pain is a sign of weakness or personal failure. So it's fascinating that the lack of treatment can in fact mimic the same symptoms as too much treatment.

Posted by: Daniel | Mar 21, 2014 12:50:48 AM

Doug --

"I think citizens having a healthy suspicion about why and how other citizens (and/or institutions) reach and advocate positions/policies is essential to a well-functioning democracy, Daniel. Trust can be earned, but it can also be lost. The medical profession has a mixed record --- like most modern institutions --- but this story highlights how we should 'follow the money'..."

This observation is right on the money, as it were. Those with a financial stake in promoting Idea X may truly, earnestly believe X. But there might be other motives, too, as Doug correctly points out.

Say, these motives: http://online.wsj.com/news/articles/SB10001424052702303630904579419033028056534

Posted by: Bill Otis | Mar 21, 2014 8:00:34 AM

Yet another conversation that starts from the DEA-deranged premise that fighting the drug war does/should take precedence over virtually everything else...including barriers the war inevitably places between people who suffer with chronic pain and medicines strong enough to subdue their pain.

Yet again we're asked to embrace adrenaline-addicted, badge-heavy thugs who get off on enforcing overreaching drug laws while making things ever more difficult for pain doctors and their patients.

Supremacy Claus is right on this one.

Posted by: John K | Mar 21, 2014 12:12:13 PM

"I think citizens having a healthy suspicion about why and how other citizens (and/or institutions) reach and advocate positions/policies is essential to a well-functioning democracy, Daniel. Trust can be earned, but it can also be lost."

Doug: I'm sure you are also including the legal, justice, educational (law school included) and government institutions on an equal footing with the medical profession - right?

For me, the legal, government and justice "institutions" have lost my trust. Most federal subsidized educational and medical professions are not far behind.

Posted by: albeed | Mar 22, 2014 9:49:01 AM

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