By Steve Ariens P.D. Pharmacist.
There are an estimated 20 - 30 million patients suffering from intractable chronic pain—most of whom require opiates 24/7 to help manage their pain. Best practices and standard of care for these patients would entail a long acting opiate and a short acting opiate - for breakthrough pain.
Presuming each prescription is for a 30-day supply-it would take 480-million to 720-million opioid prescriptions to meet the needs of this segment of our population. The last number I saw posted of legal opiate prescriptions paid (2016) was 215 million. So, we entered 2017 anticipating fewer than 30% of the legal opiate prescriptions being filled at this or lower levels going forward.
These figures strongly suggest that of the 100-million-plus of chronic pain patients and an untold number of patients dealing with acute pain would lack any opiates available for treatment.
The DEA has proven that its “beliefs”, “opinions” and other non-factual reasons that “help” the agency make decisions and take actions have little/nothing to do with the REALITY of what opiates/controlled substances are, in fact, needed by those who have a valid medical necessity.
The DEA is setting up a system to systematically deny tens of millions of people the medications that they have a valid medical necessity for.
People who overdose using illegal opiates and other substances are increasing dramatically with the typical OD having 4-7 different substances in their toxicology. Of the 64,000 claimed OD deaths, 33% have nothing to do with opiates - 15,000 are from NSAID, 35,000 are from illegal opiates/substances and the remaining are from legal prescription opiates that may have been obtained illegally and/or legal opiates used to commit suicide.
According to our current and past Surgeons General, all addictions are a mental health disease and not a moral failing and we have been fighting the war on drugs for nearly 50 years. It is time for the DEA, and others, to stop attempting to reinvent the “war on drugs wheel” over and over.
Setting up an ever-limiting supply of opiates will do nothing to slow the use/abuse of the illegal opiates that are flooding into our country from Mexico and China. Will probably do just the opposite.
It is time for the DOJ/DEA to reverse their 1917 declaration that opiate addiction is a crime and not a disease and allow prescribers to treat all patients - regardless of their medical needs - without consequences from the DEA/DOJ. Most/all of these patients are a “protected class” under the Americans with Disability Act and Civil Rights Act and further restriction and denial of access to medical necessary medication is discrimination under those Acts.
Steve Ariens is a retired pharmacist who is a chronic pain advocate. He is a frequent contributor to the National Pain Report.