In her second guest post for Points, pain relief activist Siobhan Reynolds looks at the ways in which drug war hysteria has warped public and political perceptions of pain management prescribing practices.
On April 20, the FDA, the DEA and the Office of National Drug Control Policy, along with a host of other federal agencies, announced the rolling out of REMS, or “Risk Evaluation and Mitigation Strategy,” a new federal policy that purports to confront what these agencies call the “epidemic” of prescription opioid abuse. Among REMS’ proposed solutions to the problem is physician education by DEA agents– federal law enforcement officers
with no medical training. Alongside the REMs announcement, of course, came a propaganda campaign justifying the action: articles in newspapers, magazines, law journals and even medical outlets that decried the sharp rise in overdose deaths that have resulted, the government claims, from doctors’ increased prescription of opioids over the past several years. There’s only one problem with all the hype: the data upon which such frightening claims are made is wholly unreliable.
As the esteemed authors of Forensic Science in the Dock note, blood levels of opioids recorded after death are of little help in determining whether or not the cause of death was opioid overdose. “Non-circulating blood after death is not the same thing as circulating blood before death, and evidence that the concepts of normal or therapeutic drug concentrations can be applied to blood from dead bodies is severely lacking,” they write.
The reasons for this fact are numerous. Blood pools in the body upon death, and drugs that are present in the body concentrate in different areas and at different levels depending on the location. As noted in the paper linked above and elsewhere in the medical literature, “For many drugs […], concentrations may increase by as much as 10-fold” postmortem. Moreover, patients who use opioids on a regular basis develop a tolerance to the medications that is protective against overdose to a remarkable degree. For a patient on long term high dose opioid therapy, regularly taking a dose that would be dangerous to the uninitiated is absolutely safe and effective. Without much more data on the patient’s history – such as level of tolerance, length of time taking opioids, and other medical conditions that might more accurately be the cause of death – the finding of overdose death is entirely unreliable. Nevertheless, the US government and the academic institutions and physicians on its payroll base their concerns on what amounts to junk science. Much like the thoroughly discredited press campaign against Oxycontin that occurred in 2004, this current campaign seeks to conceal the truly shocking state of undertreated pain both in the United States and all over the world.
As revealed in an American Pain Society study entitled Roadblocks to Relief, released in 1999 at the height of the pain treatment movement in the United States, an estimated 9 to 11 million Americans were struggling to live with pain that they described as the worst one could imagine. The study and the academic literature about pain fail to point out that pain of this nature is indeed an emergency and can be deadly. What is referred to as a dramatic increase in opioid prescribing between the year 2000 and 2009 is, on closer inspection, hard evidence of society’s inability to address
chronic pain in the context of drug prohibition. While the government ominously reports that opioid prescribing has increased 48% since 2000, the number of prescriptions is a scant 257 million. When considered against the numbers of Americans afflicted with serious chronic pain, estimated by the Roadblocks study to be around 9% of the population or approximately 70 million people, the number of prescriptions for effective pain relievers is actually a mere drop in the bucket.
Assuming the government’s tally of drug overdose were actually based on reliable science, the harm suggested by the finding would have to be compared to the consequences of undertreated pain. Non-steroidal anti-inflammatories are popular stand-ins for opioids, but they have caused serious cardiac damage and gastrointestinal bleeding and are much less effective, leaving pain as uncontrolled as the medicines that are prescribed to treat it. Life-threatening medical conditions develop in those left in untreated pain: heart disease, diabetes and obesity are the natural result of the body’s inability to move around. Jobs are lost, and families are destroyed. Perhaps most disturbing of all, suicide as a result of untreated pain is not tracked by government or the medical profession at any level. The system-wide denial of humane and effective treatment is covered up by the fear campaign that has been hammering away at our consciousness since the dawn of drug prohibition–a fear campaign masquerading as a public health initiative.