Yep, I Was Right. Opioid Proposals Going Forward With No Discussion Of Their Effect on Legitimate Users

A few weeks ago I wrote:

If you want to convince me of the need for restrictions on any substances, such as narcotics, you have to convince me of three things:

  1. That incarcerating users is somehow better for them than their addiction
  2. That ethically abusers of the substance are more worthy of our attention and intervention than legitimate users who benefit from the substance and whose access will likely be restricted
  3. That the negative social costs of the substance's use are higher than the inevitable social costs of the criminal black market (including the freedom-reducing policing laws implemented in response) that will emerge when its use or purchase is banned

Think in particular about point #2 when reading this:

Arizona would limit all initial opioid prescriptions to five days for new patients under sweeping guidelines recommended Wednesday by Gov. Doug Ducey's administration.

The plan also would limit maximum doses for pain medication, implement steps to taper down pain medications and require pain prescriptions to be filed electronically, rather than on paper, to limit diversion of drugs.

Consider that many legitimate users will need more than the legal maximum dosage to control their pain, and thus the issue becomes whether we want to essentially torture innocent sick people by forcing them to remain in excruciating pain in exchange for (possibly) reducing the number of accidental deaths from abusers of these drugs (I say possibly because over the last 40 years the government war on drugs has had such a super stellar track record in reducing narcotic usage).

To me the answer to this tradeoff is obvious but I am willing to admit it is a tradeoff subject to debate.  But the article linked has no debate.  There is not a single mention of any downsides to the rules, or any potential harm to legitimate users.


  1. Mercury:

    Couldn't agree more.

    Until I learned more (re: Obamacare/Medicaid/ VA hospitals etc) I was initially confused by the "opioid epidemic" in New England since it didn't mesh with my recent experience AT ALL.

    Circa 2010 I had bunion surgery on my foot (which I highly recommend BTW as the procedure is light years more advanced, clever and effective than it was decades ago). Turns out, your foot is full of little tendons, ligaments, nerves and generally lots of potential sources for pain. When the anesthesia finally wore off (hours after I got home from the outpatient procedure) it really started to hurt like hell and all I had was some weak-tea Oxycodone meds that was in fact 97% Tylenol. No amount of begging with my surgeon or primary would get me a scrip for anything stronger and I was in F-ing misery for a good 48hrs. Actually, after I realized the pills I had were no good I went cold-turkey for 24hrs to flush the Tylenol out of my system and then I hit the booze a bit but that only did so much...

    Anyway, 6 mos. later I had the other foot done and this time, after much bitching and moaning I managed to get a scrip for Dilaudid which is an old Morphine derivative that I guess isn't on the radar so much and even then I had to go to four different pharmacies before I got the scrip filled. For whatever reason this foot wasn't as painful and I didn't rely on the pills that much.

    Pro tip: After consulting informally with several docs I know, including some pain specialists, it turns out that most pain meds (opioids etc) don't really "expire" and if you can guard against the risk of them falling into the wrong hands (like kids) you just might want to hang onto that half-empty bottle of Percocet or whatever that you (or Grandma) never finished. MAYBE after many years the pills will lose a small %age of effectiveness but they won't decay into cyanide or anything like that. Could save you the BS I went through some day...

  2. Steve:

    Do you have the link to whatever story you're quoting?

  3. Matthew Slyfield:

    Over dose on over the counter pain meds instead. I've taken up to 800 mg of ibuprofrin at one time.

  4. Griz Hebert:

    When ibuprofin was a controlled substance 800mg was a single dose.

  5. kidmugsy:

    A friend was badly under-prescribed painkillers and resorted to the bottle. He was darn near an alcoholic before his family realised what was happening and swapped doctors for him. He is now told that he may drink in modest amounts but in fact has decided never to touch it again. So there's one of life's great pleasures denied to him for the rest off his days because of the incompetence or pig-headedness of a doctor. Can anyone believe that politicians will do better?

  6. joe:

    This appears to be another case of rushing to solve a problem without any knowledge of what the problem is.

    similar to Single payer/Obuma Care - - The US has the lowest life expectancy of any industrialized country, (of which all the others have single payer and/or govt health care or some form thereof) and therefore we need healthcare reform.

    That being said. - there is a lot of pain med abuse
    That being said - very little of pain med abuse results in ancillary criminal activity.

    I dont have an answer for the solution -

    I will add - at least in regard to acute injuries, getting off the pain meds as quickly as possible accelerates the rehab process
    Wtih regard to chronic pain, - at least the moderate level of chronic pain, my perception is that it does delay the rehab process and possibly has the effect of terminating the rehab process - in effect greating a permanent pain. (this is based on my discussions with a few ER doc's that I am socially acquinted with)

  7. ErikTheRed:

    Bringing up this topic almost invariably brings in someone whose family member battled drug addiction and is deeply embracing the idea that more prohibition would have eliminated the problem. Not to be mean, but these people must be fucking high... and I say this as somebody who had two family members basically die from addiction. This is a mental health problem. People who want to escape reality will find a way to do so. One family member that was living with us near the end would drink cooking wine or sniff gasoline fumes or basically do whatever was available. They'd probably drink bleach if we left it unattended.

    There have been real problems with doctors overprescribing opioids, but those are doctor problems not drug problems. There are plenty of doctors that shouldn't be allowed to tie their own shoes unsupervised, let alone practice medicine (same with most other professions - how these people become credentialed is beyond me). Another problem is that there's a batshit insane fear of a very safe and effective "middle-of-the-road" painkiller between the over-the-counter stuff that's only effective to a very limited point and opioids that are very effective, but potentially addictive and lethal: marijuana. It works well in many circumstances, isn't physiologically addictive, and you can't OD on it. It's also extremely inexpensive compared to other remedies. These days it's become very "corporate" - branded and scientifically controlled for recreational use. Different strains affect different people in different ways, but if you find what works for your body you can get very consistent results and in many cases you can find something with minimal intoxicating effects (relaxed and happy, but still mentally functional).

  8. Colin:

    As a Dr. who prescribes these on a daily basis, I will say that the current restrictions have actually encouraged larger opiate prescriptions. While non-controlled medications can be called in, opiates require a signed script. So when you discharge your patients back home across the state and they run out of pain medications their only options are limited. They can do without, find an appointment with a local physician, or drive hours back to your hospital to pick up another script. Those who attempt to prescribe less must constantly deal with unhappy phone calls and attempt to workaround. Others just write a huge script off the bat and get to sleep uninterrupted with great satisfaction scores.

  9. Bistro:

    burn down their houses. let them wonder at the pain of people who forsake the law for relief from pain.

  10. Bistro:

    Srsly, if people just want to check out, why hassle them? It's almost beyond belief that thc is legal in some states, allowed in others and banned by the DEA and the Federal government.
    Just step out of the way and let people get what they want. How can that be worse than the Draft or the democratic party?

  11. Matthew Slyfield:

    Yep, 800mg is the "prescription" dose.

  12. Matthew Slyfield:

    "The US has the lowest life expectancy of any industrialized country,"

    A lot of that has to do with violent crime and other sources of fatal injuries. Fatal injuries say nothing about the quality of our health care system.

    If you remove fatal injuries from the calculation,the US has the highest life expectancy among OECD nations.

  13. blok:

    In old England, up to 30% of patients presenting to GP do not have anything wrong with hem or have been wrongly diagnosed by Dr Gooogle.
    Their symptoms are real, they are psychosomatcally challenged. Very few are malingerers.
    But why spend public money on drugs that atack a disease that doesn't exist? CBT and psychiary would be more effective, and faster.

  14. joe:

    That was one of my points - proponents always cited the lower life expectancy as one of the reasons for needing healthcare reform/obuma care - but they never bothered to understand the reasons for the difference - and therefore came up with a boondoogle that did nothing to improve healthcare, costs healthcare delivery, etc or even healthcare.

  15. kidmugsy:

    "As a Dr. who": that elicited a chuckle.

  16. me:

    Agree. My perspective on opioids and other drugs is that everyone ought to be able to buy them at any pharmacy with a valid ID, as cheaply as possible.

    Addicts will always be addicts and find a way (NPR had a story about addicts keeping bad teeth around so that they could get prescriptions from dentists), and failing that, there are always the obligatory dealers on street corners.

    All that control measures cause is an increase in street value, effectively helping support crime.

    If we sold them openly and registered consumption, we would cut off criminal enterprise in the sector, gain data on who consumes how much (and that in turn could be used to check on clearance for jobs/licenses).

    The other side effect would be that people could decide for themselves which pain medication is appropriate for them and their level of pain, as opposed to have only the option of taking OC drugs or taking the doctor prescribed meds, which would remove the "doctor as fixer" problem.

  17. tmitsss:

    I keep thinking if I just give up a few more rights we can win the war on drugs, but I'm running out of rights.

  18. Paul Treder:

    You have "diagnosed" the situation quite accurately. And interestingly, the increased workload and burden on clinicians to comply with new rules and regulations ties in well, albeit more "sideways" rather than directly, with your previous comments. There is a sigficant added complexity to writing prescriptions fot these kinds of medicines, but no added staff to do the required work to be in compliance. It seems neither the bureaucrats nor the corporate management take this into consideration when new rules and regulations go into effect. One more reason why the practice of medicine is dropping in popularity and many of us "old timers" are retiring earlier than originally planned. Sad.

  19. SamWah:

    I was on 600s 4xday, and got a duodenal ulcer.