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.