Two different Fed Agencies – Two Different Paths of Enforcement – Neither Successful

Two different Fed Agencies – Two Different Paths of Enforcement – Neither Successful

By Steve Ariens.

Back during the Nixon administration, Congress created two different Federal agencies to oversee the sale of similar products.

In 1970, Congress passed and Nixon signed into law the Controlled Substance Act which replaced the Federal Narcotic Bureau with the BNDD (Bureau of Narcotic and Dangerous Drugs) which a couple of years later morphed into the DEA (Drug Enforcement Administration)

In 1972, Congress passed and Nixon signed a bill that created the ATF (Alcohol, Tobacco and Firearm) which was previously under the US Treasury.

Both agencies were in charge of regulating products that could be both potentially addicting and lethal. Both have to deal with licensing manufacturers, wholesalers, and retailers. Only the DEA has a to license and oversee a learned intermediary (prescriber) between the wholesaler and the end purchaser.

Initially the ATF started with a $74-million-dollar budget and 3800 employees which today’s budget is $1.2 billion and 5000 employees. The DEA started with a $42 million budget and 1500 employees which today’s budget is $2 billion and 12,000 employees. In addition, most states have some sort of “drug enforcement” staffing at city/county/state levels and it has been reported that the entire war on drugs cost $81 billion each year.

The products that ATF oversees account for the following annual deaths:

Guns:       19K suicides – 12K Homicides

Tobacco:  450,000 deaths

Alcohol:   100,000 deaths

The products that the DEA oversees account for the following annual deaths.

Legal opiates kill about 5 thousand while illegal opiates kill 7 times that.

Some find it interesting that these two similar agencies have taken two very different paths to pursue their legal charge and authority.

Only the DEA decided to classify some of the substances that they had authority over as being “illegal substances”, even though many/most/all of those illegal substances may have certain medicinal benefits.  Since the substances are classified as illegal, no one can even do clinical research on them to disprove what the DEA has determined has “no medicinal value”.

From a “body count” perspective, the ATF is considerably ahead of the DEA, yet the DEA’s body count has been labeled as anywhere from an epidemic to a crisis, and at the same time…the actions of the DEA is causing untold number of intractable chronic pain pts being denied their medically necessary medication. Has cut production quotas of the manufacturers, convinced Federal and State bureaucrats and insurance companies to reduce the availability of legal opiates for pts with valid medical needs.

According to this chart based on CDC data, the number of prescriptions filled in 2006 and 2016 are about the same. (It might have even decreased a bit in 2016). While the number of overdoses nearly DOUBLED, it would appear that while the DEA has been successful in getting the number of legal opiates prescribed to decrease. They have been similarly a failure in helping to prevent overdoses.  Of course, the primary function of the DEA is not to prevent diversion or OD’s but they are LAW ENFORCEMENT. Their primary job is to arrest those that – break the law – are involved in diversion.

There are an estimated 100 million-plus chronic pain patients. That being said, there are probably 20 – 30 million pts suffering from intractable chronic pain … suffering from moderate – severe pain and have a valid medical need of 24/7 opiates.  The balance of that 100 million are probably managing their pain part or full time with NSAID’s and maybe “as needed” opiates.

What is considered best practice and a standard of care in treating intractable chronic pain is for the patient to have a long acting opiate and an immediate release opiate for breakthrough: Meaning that each of those 20-30 million patients will have 24 prescriptions filled each year, presuming each prescription is for 30 days.

Doing the math, those 20-30 million pts would have 480 – 720 million prescriptions/yr. Notice the chart that in 2016 there was a reported 215 million opiate prescriptions filled. That 215 million number includes opiate prescriptions for treating acute pain and/or those with chronic pain that needs opiates on a as needed basis.

Recently AG Session stated that the DOJ/DEA was going to target prescribers and pharmacies based on “outliers” determined by statistics and “numbers”. I wonder what databases they are using to come up with those statistics?

Steve Ariens is a retired pharmacist and chronic pain advocate who contributes to the National Pain Report.

Subscribe to our blog via email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Leave a Reply

15 Comments on "Two different Fed Agencies – Two Different Paths of Enforcement – Neither Successful"

2500
  Subscribe  
newest oldest
Notify of
Sandy Auriene Sullivan

Isn’t that terrifying. “Recently AG Session stated that the DOJ/DEA was going to target prescribers and pharmacies based on “outliers” determined by statistics and “numbers”. I wonder what databases they are using to come up with those statistics?”

So not at all based upon whether or not they broke the law? Only the appearance of maybe violating…. wait violating what law? We know the guidelines are simply recommendations – not law. Not yet, despite treated as such.

So that last paragraph regarding ‘outliers’ being the new DEA target is only going to terrify more doctors and pharmacists? More hospital doctors too.

Not even my brother with end stage cancer; very much terminal can get so much as a norco right now. Why? State insurance doesn’t cover pain specialists. Yes, even terminal cancer patients now need to see the pain specialist. Of which fewer and fewer exist. After 12 mos [he wasn’t supposed to last 9 mos] he finally saw an oncologist. Not many in his area, still not prescribed anything for pain. My brother will not seek in home hospice; not when my niece is a nurse in…. oncology at the hospital.

Who are the outliers going to be and under what law will they be prosecuted? None! They raid and make these people so afraid it is simply easier to NOT risk your license than it is to care for the terminal and the incurable patient in pain.

I agree with comments. The patients documented, responsible use of medication to a tailored, beneficial non self health harming issue with opioid medication seems to have no merrit. The same with statistics. No alternatived resource for lets agree, millions or responsibly using, resposible prescribing based upon drug screening, pill counting with now sidelined functioning patients for years and decad> We are simply “fallout” from the war on “opioids”. Lets’s get to the nitty gritty, shut down illicit infiltration of people killing illicit drugs, the unintentional drug overdose of the simple one time use of powerful illicit drugs and seperate the responsible opioid medication providers and recepinents and the BS attack upon the medically neccessary needed opioid medicaion to those of us that can prove, provide documentation of ONLY beneficial use with enabled lives. HHS, CDC, :policy: backed by DEA enforced compliance is killing people, one way or the other. To our “:policy” makers and the elect that is ignoring the realisitc issues of the positive benefit of opioid medication use need to jump off the opioid crisis pain train and take a real, close look at the under managed pain iissues with some amount of exercised individual thought of patients that truly benefit of a tailored dosage with recurring examinations, pill counting, and double urine screening if, that it is what it takes to make dot/gov “happy.” Thanks Steve for your insightful look into the sattistics and explantory graph! Keep the pressure on against an asinine policy that has become even more antiquated against responsible, last resort medication users!

Yesterday AG Sessions stated that “Sometimes you just need to take 2 Bufferin or something and go to bed.” as his answer to the opioid issue. Is it any wonder that those of us in chronic pain are literally reaching the end of our rope? The US government will give billions of dollars to combat the “opioid scourge” but it will primarily go to law enforcement to arrest opioid users and put them in jail. Haven’t the last 40+ years of the “War on Drugs” showed that this approach does NOT work? It is a health problem not a crime problem. They want to put users in jail to write them off not help them get off drugs and live better lives.

Chronic pain patients whose lives are made better, more functional by opioids fly in the face of the DEA ideology that opioids lead to a life of ruin. When patients have a stable supply with dosage and quality controlled then opioids are a life-saver for many as they are a source of comfort and hope where nothing else works. This is totally different than street drugs where a person doesn’t know what they are getting. The drug, dosage and quality are all a mystery. That’s why people are dying.

Many chronic pain patients have had their opioid medications reduced and/or removed, especially veterans. How are they helped by this? What are they supposed to do? Why are they targeted when they have nothing to do with those overdosing on opioids? Why is our government against the relief of chronic pain?

Steve, As always, Excellent post! Thank you! If only you could convince the DEA of their wrongdoings.
Steve or Ed,
By the way, is Live Support Group up and running anymore? I came on there on Saturdays for a few months but then life got in the way.
In the meanwhile I wasn’t getting my reminder emails anymore. I just checked for it online and it won’t give me any info.
Please advise… Thank you for all that you do on the CP community! Maureen M.

The DEA is also responsible for the arrest and conviction of countless millions for non-violent drug offenses most of them black and brown. There are people serving life sentences for growing weed while rapists serve a few years, at most, and if they’re rich and white, get out after less than 6 months. Even now, with recreational weed legal in something like eight states, people in other states are still getting sentenced for decades for growing weed. Here in Oregon, the dispensaries check IDs but no longer record any personal information to prevent the DEA from getting access to their customers if they are raided. We pain patients and our health care providers are just the newest victims of this pointless, immoral, and ruthless drug war.

This administration has got to go…they represent draconian logic and project torturous mandates/guidelines…follow the money.

You could NOT be more wrong about conflating the two populations!
Most, of my brothers and sisters w CPP (esp intractable pain) were NOT depressed until AFTER their particular pain disease origin. It’s ‘scientists’ like you whom are drinking the media KOOLAID, trying to draw like comparisons between ‘substance challenged and ‘organic’ centralized pain. I would ask that you further educate yourself of the many different basis underlying INTRACTABLE PAIN. It’s those like you whom are responsible for all the suffering behind the Opiod prohibition policy of PROP and the cdc. https://www.coccyx.org/medabs/IntractablePainSurvival.pdf

OPIOIDS, ARE NOT OVERDOSING PEOPLE, PEOPLE ARE OVERDOSING, THEMSELVES !!!!!!! THINK-ABOUT IT

Thanks Steve for breaking it all down for us. Looking at the statistics it makes you wonder WHY is this crackdown on dr’s & patients happening? Pain patients are probably the most monitored group out there yet we’re lumped together with street abusers!! From all we know from history when drug abusers don’t have access to their “drug of choice” they will abuse a different drug. I still can’t fathom the way patients in the pain community are being treated! Some pain dr’s are extremely sympathetic but too many others have become cold and uncaring. Starting from a position of being skeptical is not a good way to start the dr/patient relationship! Shouldn’t a patient have a caring dr trying to help instead of feeling traumatized, interrogated or not believed at all? And even with a documented disease!!
I don’t know if it’s true but some have said they are teaching these techniques to pain dr’s now. To always be skeptical, don’t get close to the patient etc.. I don’t know if rudeness is included or just their choice. All I know is that when faced with having to change dr’s due to dr’s leaving their practice to retire or to focus on performing steroid surgeries, the new anesthesiologists of this day & time have been sent into the “pain world” with horrible “bedside manners” and a weird unachievable mission of judging patients by looking for “red flags” and maybe how patients “look”! There are websites now dedicated to tell patients what NOT to say to your pain dr! Don’t mention that “opioids” are what helps you. Don’t pooh pooh steroid surgeries, even if you’ve been there done that. What’s harder to believe are the limits being placed on those with cancer and those in hospice! I’m assuming nursing homes as well!! There’s nothing worse than constant debilitating pain, met with indifference, from those who legislate how much pain is acceptable (to them) for others to suffer! It’s unconscionable!!

Great. So what ard chronic pain patients supposed to do? We’re NOT the ones causing the number of overdoses to skyrocket. We’re not the problem, and we don’t even get “high” when we use opioids. We MIGHT get an edge taken off the pain—that’s it. Yet we’re being punished. Those who have a legitimate need for these drugs are having them taken away because doctors are so afraid to prescribe them, and pharmacies even more afraid to fill them!!!

Thank you for standing up with the truth. I’ve been cut from 525 a day to 255 a day and it is cruel to take away after yrs of being able to cope, Back to not being able to live as comfortable. I wouldn’t mind if they only had something that works to replace the meds with. Making people suffer is just WRONG.

Our tax dollars at work and as usual there’s nothing helping private citizens!

on the news this morning FDA states KRAMTON has opoid properties .stock up now it will be rescheduled .I find this Crappy it helps with pain but that is JMO

In all of this, I do not understand why the government is even INVOLVED in a private citizens doctor/patient relationship in ANY WAY, unless that private citizen has broken the law. Still only that private citizen should answer for that. Not their doctor,pharmacist,nor any other private citizens and their medical team. The further this goes,the more disastrous the result will be. The ILLEGAL drug trade will FLOURISH in this environment. One need only look back at prohibition to see that is true. The crime rate will also soar as people who need meds or their family members will cross that line out of sheer desperation. Ince again,look to the past to see any time the “government ” ties a little bow around one of its pet projects,the criminal element crawls out of the woodwork to “help” get people what they need-for a cost-a very high one. ANYTHING can be bought in this world for a price and if you dont have the money theres always a way to get it….I only see disaster on the horizon.

Mr. Ariens, God bless you! You are SPOT on! I find it absolutely ludicrous to limit those in agony, who’ve always taken their medications correctly and done exactly what is asked of them because a few ruin it! I’ve watched my spouse who was an 18 year full time/paid Captain fireman, an employee for Homeland Security and an instructor with the South Carolina Fire Academy, have his entire world changed ddramatically following a four wheeler accident which fractured C 6 & 7. In layman’s terms he broke his neck! To see the excruciating pain he deals with daily is unreal! And now…the hoops one has to jump through to receive his prescription medications to be able to live with some sort of normalcy! There is without a doubt a enormous problem when the DEA has this much power!?