By Steve Ariens.
For the Chronic Pain, these are very, very trying times. The pressure on opioid prescribing combined with the lack of any public policy progress in developing a chronic pain policy have created a malaise that is palpable.
One very intelligent and somewhat iconoclastic chronic pain advocate is retired pharmacist Steve Ariens. He has been a valued contributor to the National Pain Report over the past several years.
Recently he wrote a number of us an email that struck me as something we should share to our audience, which he agreed we could share. Read it and tell us what you think.
Dear Fellow Advocates,
I am concerned about the bureaucratic “knee jerk” reaction about what is happening. With more and more information coming out about the illegal opiates showing up in overdoses, in some areas up to 99%, it hasn’t made a dent in the direction and intensity of the war on drugs. if anything, it is behind an acceleration. Our judicial system has seemingly been knocked off the tracks.
One segment on “60 minutes” interviewing a former disgruntled DEA employee appears to has set the wheels in motion in undoing the 2016 law that was supposed to enable chronic painers to have better access to therapy.
The DEA seems to be going after prescribers that are 50-to-60 years old, and those that have a fairly decent net worth–almost as if the DEA is maintaining a spread sheet on prescribers with their estimated net worth and using that to target the prescribers that are worth going after to use civil asset forfeiture to the benefit the DEA’s coffers.
When you think about it, confiscating illegal substances has little/no financial upside for the DEA–street dealers don’t have a lot of assets other than product to sell.
After their success with the Tobacco industry back in the 1990 and the 200 billion settlement for selling a legal product…it would appear now that the various state AG’s, cities and counties are lining up to going after the Pharmaceuticals and drug wholesalers… perhaps to reap another huge settlement to replace the tobacco settlement money that is scheduled to end in a few years.
Wholesalers are rationing controls to pharmacies, and normally that would be considered restraint of trade and collusion, but since it is being “encouraged” by the DEA, the Department of Justice is not going pursue charges on those wholesalers and three wholesalers who control most of the market.
These same state Attorneys General have issued a letter to the insurance industry that they need to pay for less opiates. One can imagine if the insurance industry does not cave to their “request”, they could be the next industry to get sued for assisting the opiate crisis. Besides the insurance industry makes more money by not paying for any particular therapies. The insurance industry’s bottom line is going to fare very well if they comply.
There was a recent article and one insurance company plans on cutting what they reimburse for opiates by 50% over the next few years. Chronic pain is already the most intentionally under treated chronic disease and looking forward to a 50% reduction and that does not take into account that our population is growing about three percent a year.
Pharmacists are in a “safe harbor”. The Boards of Pharmacy are sitting on their hands about denial of care, chain corporate headquarters could care less if their pharmacists fill control. And, remember that the insurance companies and PBM’s make money if pharmacists refuse to fill prescriptions. We have a growing surplus of Pharmacists. By 2025 we will have 50,000 pharmacists looking for jobs that don’t exist.
It doesn’t help that Congress is made up of attorneys (40% are lawyers by education) and the common denominator in the war on drugs is our judicial system. $81 billion funnels into all parts of our judicial system every year from the cop on the street to prosecuting/defense attorneys, courts, jails/prisons, Attorneys General and all the way up to the DOJ.
In 1917 the judicial system declared opiate addiction was a CRIME and not a DISEASE and would jail any prescriber caught treating/maintaining an addict. The DEA licenses clinics and prescribers to treat the CRIME of addiction with Methadone/Suboxone – two different controlled medications.
The chronic pain community is being painted into a corner and abused by those who have the authority to create laws and/or create new interpretation of existing laws–many of which may be unconstitutional in the first place–but no one has taken the trouble to challenge their being constitutional or not.
I believe that disseminating the TRUTH and FACTS is going to have to unwind the propaganda that the DEA has put out over the past half century. All one has to do is look at all the press releases from the 25 district offices and HQ since 2002. Take a look to see what we are up against.
In my opinion, the chronic pain community has few choices but to create a legal defense fund to go after some of the low hanging fruit–challenge the constitutionality the original judicial system’s decision that opiate addiction is a crime as being unconstitutional–if nothing else our previous surgeon general claimed that addictions are a mental health disease and not a moral failing.
1917 was during our country’s “prohibitionist period” … it was before the alcohol prohibition, it was before women were given the right to vote. The Harrison Narcotic Act 1914 was based on racism and bigotry. I believe most of what is happening is in violation of the Americans with Disability Act and Civil Rights Act.
Where do we start?
Is the chronic pain community going to continue to run in place?
The time for action is long overdue.