Vicodin, Vicodin Everywhere, But Don’t Expect a Refill

Sometimes the best intentions lay track to the very worst policies. If you need proof, look no further than the disastrous comedy of errors known as the War on Drugs. Four decades of Manichean social policy and zero-tolerance policing has cost us roughly $1 trillion, filled our prisons to bursting with mostly non-violent offenders, and has had little to no impact on overall rates of drug use.

Bred out of a genuine concern for our nation’s youth, what once seemed like a noble and winnable endeavor has been revealed as a miserable failure. Even the U.S. drug czar himself has admitted as much, telling a reporter in 2010: “In the grand scheme, [the Drug war] has not been successful.”

But chances are you already knew all that.

What you may not know is that the fallout from this fruitless and costly undertaking has been laying waste to one of the nation’s most vulnerable populations—the chronically ill and dying—who, in spite of nearly unlimited access to some of the best medications the world has ever known, are facing an epidemic of under-medication for pain. You heard me right. Under-medication.

116 Million Americans Suffer From Chronic Pain
I know what you’re thinking, and you’re right … partly. As I have detailed in this very column, America is literally awash in pharmaceuticals. And if you happen to have heartburn or depression, or simply can’t get it up, you can pretty much eat pills like candy. But thanks to draconian drug policy and the trickle-down effect it’s had on our nation’s physicians, if the worst of your problems is an inability to stand up without a bolt of lightening setting fire to your tattered nerve endings, there’s a good chance you have little more to ease your suffering than a bottle of 800-milligram Ibuprofen and a referral to a good chiropractor.

We’re not talking about a small group of people here. It’s estimated that 116 million Americans suffer from chronic pain—an often misunderstood condition tied to abnormalities in the way neurons in the brain react to stimulus—while another 25 million experience acute pain as a result of injury or surgery. Add to that the roughly 12 million Americans living with cancer (approximately 80 percent of whom report attendant pain), and the potential number of affected individuals becomes staggering.

The World Health Organization has long held that restrictions on the legal use and availability of opioid analgesics like morphine and Oxycontin are an impediment to adequate pain care and has beseeched governments to stay out of the doctor’s office.

Nevertheless, 48 U.S. states enforce some form of restriction on how medical providers may dispense pain medication, how much they can prescribe, and to whom.

Last year Washington State adopted new restrictions on the dispensing of opioid painkillers that are among the strictest in the nation. The new law holds doctors accountable for tracking patient behavior and administering random urine tests, and it sets a threshold of 120 milligrams of morphine before a patient must get a special evaluation, among other things. The net effect has been nothing short of drastic. By December 2011, the Seattle Times reported, 84 pain clinics and hospitals had stopped prescribing pain medication to new clients, while hundreds of existing patients were cut off from their only source of relief. At least half a dozen states are now said to be considering similar laws.

According to a 2009 report by Human Rights Watch, restrictions like these have a ripple effect that leads doctors to withhold medication out of fear of prosecution or censure, even if those fears are ungrounded.

Pennsylvania’s Efforts to Monitor Prescription Drug Use
Here in Pennsylvania a push is underway to expand the state’s prescription database to track patients’ drug use and weed out “doctor shoppers.” The bill, introduced by Republican State Rep. Gene DiGirolamo of Bucks County, is targeted—rightly—at drug abusers who either dupe doctors into being their pushers or count them as co-conspirators, and those who divert medication to illegal uses. It currently has the support of the commonwealth’s medical establishment, but history has shown that adding another layer to an already burdensome system will invariably make it harder for those with legitimate medical conditions to receive palliative care.

Myths About Prescription Drug Use
“Narcophobia” is grounded in several enduring misconceptions about the physiological effects of opioid narcotics and the science of addiction. Foremost among them is the belief that because a patient is on extremely high doses of drugs, they must be overmedicated. Nothing could be further from the truth. Opium-based medications and their synthetic derivatives rapidly lead patients to develop a physiological tolerance to the drug, which means one man’s overdose is another man’s aspirin.

A dose that might be big enough to put down a elephant may hardly cure a headache in someone who has developed this level of tolerance. Simply looking at a dose objectively without knowing a patient’s history is shortsighted and scientifically unsound.

Next in line is the myth that dependence equals addiction. By their chemical nature, narcotics create a physical dependency, which means abruptly stopping them will invariably lead to severe withdrawal symptoms. That might seem like addiction, but it’s not. Addiction may have a physical component, but at heart it’s a psychosocial disorder characterized by obsessive-compulsive behavior and persistent drug seeking. A patient who is taking their medication as prescribed may be physically dependent on it, but that doesn’t mean he’s an addict.

Lastly is the myth of long-term side effects. Unlike relatively new drugs like Prozac or Viagra—whose long-term effects remain to be seen—the effects of extended use of opioid narcotics are pretty well documented; and they’re negligible. In healthy individuals there is no known organ toxicity attributed to sustained use of medications like morphine or oxycodone (the active ingredient in Oxycontin). Pills like Percocet and Vicodin do have toxicity, but it’s the acetaminophen (the active ingredient in Tylenol) that gets you, not the narcotic.

By contrast, studies have shown persistent, untreated pain can have disastrous effects on the human body and mind, and can lead to depression, wasting and delirium.

Pennsylvania’s own Founding Father Dr. Benjamin Rush said: “Pain must be regarded as a disease … and the physician’s first duty is action—heroic action—to fight disease.” Addiction to prescription drugs is a serious problem that needs to be addressed. There is no doubt about that. But instead of casting a wide net that is more likely to keep legitimate pain sufferers from getting the medicine they need than stop drug abuse, let’s do what’s proven to work best time and time again: invest in education and treatment and let doctors do their jobs without interference.