By Angelika Byczkowski.
It’s truly astonishing how our schizophrenic government can straddle two utterly incompatible versions of reality.
On the one hand, the government collects drug overdose data and creates beautiful graphics and charts that show it’s now illicit fentanyl, not prescription opioids, driving the overdose crisis.
On the other hand, the same government is still creating new policies to limit the use of these prescription medications, supposedly with the goal of stemming the overdose crisis, which is no longer driven by prescription opioids.
Opioids are framed as “evil”, and any use of them and subsequent physical dependence on them is framed as a “substance use disorder” (thanks to the DSM-V). This taints even medicinal opioids with the spectre of addiction, putting them into the same category as the most famous opioid of all: heroin.
When the leading anti-opioid activist, A.Kolodny, reinforces this thinking by calling pain medication “heroin pills”. This effectively declares open hunting season on opioid prescribers for the Drug Enforcement Agency (DEA).
In the form of prescribed medications, opioids are carefully counted and documented, with this information held in various massive databases, like a Prescription Drug Monitoring Program (PDMP). Patient privacy is routinely violated as law enforcement officers look through these databases at will, without a warrant.
DEA agents only have to look in a database and run a search for the doctors prescribing the most opioid milligrams. And the doctor’s name and address is documented right there with those numbers.
This makes it easy to hunt down doctors who prescribe more opioids than average. Regardless of whether it happens to be a pain doctor or a dermatologist, the numbers reign supreme.
They assemble a SWAT team, call the local news to give them a heads-up, and stage a “raid” on a peaceful doctor’s office, executed as though they were going after a “real” drug dealer who is usually armed and dangerous. They arrive at the office in full body armor, bristling with weapons, terrifying doctors, staff, and patients. It’s a great photo op.
But completely ineffective.
The same government that’s forcefully reducing the availability of prescription opioids has itself published data that shows current overdose deaths are mostly from illicit fentanyl, not prescription pills.
Fentanyl is a manufactured opioid so strong that doses are measured in mcg, mere millionths of a gram.
“Even those with opiate tolerances are at high risk for overdoses. Once the fentanyl is in the user’s system, it is extremely difficult to stop its course because of the nature of absorption. Illicitly synthesized fentanyl powder has also appeared on the United States market.
Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately, and often the resulting mixture may be far too strong and, therefore, very dangerous
Some heroin dealers mix fentanyl powder with heroin to increase potency or compensate for low-quality heroin.”
Even a little bit too much is deadly, and illicit drug dealers rarely have the technology to measure such miniscule amounts. Cheap fentanyl has slipped into all kinds of illicit drugs, as a powder or even pressed into pills. The CDC’s own graphs show this is the cause of ever more frequent “opioid” overdoses.
But to find the drug dealers peddling this lethally potent mix is difficult, time consuming, and extremely dangerous. These guys know how to hide and they fight back with even more powerful weapons than those used against them. They are ruthlessly violent and rule by terror.
In these circumstances, it’s no surprise the DEA prefers going after well-documented doctors and their patients. With conveniently measurable numerical data - and none of that messy descriptive data about pain and suffering - milligrams of opioids prescribed becomes the de facto measuring stick for success of “opioid policy”.
To be seen as righteous warriors slaying the opioid demon, policymakers want numbers to prove it and prescription databases provide them. Aspiring politicians can show concrete proof that the numbers of opioid milligrams are changing as desired.
That these declining numbers don’t correlate with the surging rates of addiction and overdoses doesn’t seem to be noticed, certainly not by policymakers, and rarely by the media, which recklessly ignores this truth in the pursuit of a good addiction story.
We hear only about milligrams of opioids - the levels of pain they are prescribed for are literally never mentioned, as if dosages were completely unrelated to a patient’s medical condition.
The arbitrary numeric dose ranges for pain patients set by the CDC are not based on any real-world data. They were simply “decided by committee” as though all those milligrams of opioids were prescribed for some generic “average” person with “standard” pain.
Fewer milligrams prescribed is considered success in the drug-war. And in corporate health care, doctors are being bribed with bonuses to ignore their “healing” purpose and effectively torture their patients with unrelieved pain.
Chronic pain is the only medical problem for which it’s considered “good practice” to deny effective medication without solving or even addressing the medical issue the medication was prescribed for.
All else is pushed aside by the single-minded focus to bring down the milligrams of pain relief prescribed, while the resulting misery inflicted on patients is just “anecdotal” and apparently, irrelevant. Doctors are not treating patients, they are treating medical charts.
Perhaps worst of all, the patients themselves are blamed for taking their necessary and prescribed medication because their pain is considered immaterial. Most believe that pain patients “caused” and are still “causing” the overdoses, even when those are from illicit street drugs.
The insane persistence in refusing patients the pain relief they need brings to mind a frightening scenario:
“Those who torment us for our own good will torment without end,
for they do so with the approval of their own conscience”
Until she was disabled by progressive pain and fatigue from Ehlers-Danlos Syndrome and Fibromyalgia, Angelika was a high tech IT maven at Apple and Yahoo, and a competitive endurance athlete. She lives in a rustic cabin in the redwood forests of the Santa Cruz Mountains just up the hill from Silicon Valley with her husband and various 4-legged kids.
When her pain allows, she spends her limited energy researching, writing, and blogging about Chronic Pain, EDS, and Fibromyalgia at https://EDSinfo.wordpress.com and writes poetry to sustain her sanity.