The government’s efforts to get between people and the drugs they want have not prevented drug use, but they have made it more dangerous.
JACOB SULLUM | FROM THE APRIL 2018 ISSUE
Craig, a middle-aged banking consultant who was on his school’s lacrosse team in college and played professionally for half a dozen years after graduating, began developing back problems in his early 30s. “Degenerative disc disease runs in my family, and the constant pounding on AstroTurf probably did not help,” he says. One day, he recalls, “I was lifting a railroad tie out of the ground with a pick ax, straddled it, and felt the pop. That was my first herniation.”
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 non patients. 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.
Former New Jersey Gov. Chris Christie, who chaired the President’s Commission on Combating Drug Addiction and the Opioid Crisis, invokes that narrative when he talks about “the injured student-athlete who becomes addicted after [his] first prescription” or remembers the law school classmate who died of an overdose after getting hooked on the oxycodone he was taking for back pain. Such examples are misleading because they are rare, accounting for only a small percentage of opioid-related deaths.
Contrary to the impression left by most press coverage of the issue, opioid-related deaths do not usually involve drug-naive patients who accidentally get hooked while being treated for pain. Instead, they usually involve people with histories of substance abuse and psychological problems who use multiple drugs, not just opioids.
Conflating those two groups results in policies like the pill count that left Craig without the pain medication he needed to get out of bed in the morning, go to work, and lead a normal life. The rationale is that cutting people like him off will stop them from ending up dead of an overdose in a Walmart parking lot next to a baggie of fentanyl-laced heroin.
But the truth is that patients who take opioids for pain rarely become addicted. A 2018 study found that just 1 percent of people who took prescription pain medication following surgery showed signs of “opioid misuse,” a broader category than addiction. Even when patients take opioids for chronic pain, only a small minority of them become addicted. The risk of fatal poisoning is even lower—on the order of two-hundredths of a percent annually, judging from a 2015 study.
Despite such reassuring numbers, the government is responding to the “opioid epidemic” as if opioid addiction were a disease caused by exposure to opioids, a simplistic view that ignores the personal, social, and economic factors that make these drugs attractive to some people. Treating pain medication as a disease vector, the government has restricted access to it by monitoring prescriptions, investigating doctors, and imposing new limits on how much can be prescribed, for how long, and under what circumstances. That approach hurts pain patients by depriving them of the analgesics they need to make their lives livable, and it hurts non medical users by driving them into a black market where the drugs are deadlier.
A large majority of opioid-related deaths now involve illicitly produced substances, primarily heroin and fentanyl. As usual, the government’s efforts to get between people and the drugs they want have not prevented drug use, but they have made it more dangerous.
LINK TO ORIGINAL ARTICLE:
Degenerate Disc Disease, Jacob Sullum, narcotics, OxyContin, BioFreeze, Jacob Sullun