Are restrictions on opioids a threat to human rights?

https://www.washingtonpost.com/opinions/are-restrictions-on-opioids-a-threat-to-human-rights/2018/04/30/42c7ac32-4c86-11e8-af46-b1d6dc0d9bfe_story.html

Fatal overdoses of prescription opioids were rare before 1999. Then doctors, influenced by pharmaceutical industry marketing, began prescribing them for chronic non-cancer pain. By the end of 2016, prescription opioids — not illicit heroin or fentanyl — had claimed 200,000 lives.

Now, at last, the opioid wave has crested. Per capita usage declined for the sixth straight year in 2017, according to IQVIA Institute for Human Data Science , a health-care consulting group. Changes in public policy, including long-awaited prescribing guidelines issued by the Centers for Disease Control and Prevention (CDC) in March 2016, promise to sustain this life-saving progress.

Or maybe they’ll lead to human rights violations. Believe it or not, that’s the premise of a new investigation by the New York-based nonprofit Human Rights Watch (HRW), known for its exposés of war crimes around the world.

HRW is seeking evidence that the CDC guidelines and other efforts to modulate opioid prescribing result in patients being cut off from vital medication, in violation of their right to appropriate health care.

The group “is looking for testimonials from chronic pain patients who have been forced or encouraged to stop their opioid medication by physicians or pharmacists,” the Pain News Network reported in March.

 

“The CDC clearly knows what’s going on and they haven’t taken any real action to say, ‘That is not appropriate, involuntarily forcing people off their medications. That’s not what we recommended,’ ” Diederik Lohmann, director of health and human rights for HRW, told the network, which says two-thirds of its readers take opioids, mostly for chronic, non-cancer pain. “When a government puts in place regulations that make it almost impossible for a physician to prescribe an essential medication, or for a pharmacist to stock the medication, or for a patient to fill their prescriptions, that becomes a human rights issue.”

Human Rights Watch is not alone; a recent cover story of the libertarian magazine Reason denounced “America’s war on pain pills.” And, of course, patients who have become dependent on opioids must be treated compassionately.

But even after the recent decline in prescriptions, the U.S. opioid rate of consumption in 2017 — 676 morphine milligram equivalents per adult — was five times the 1992 rate. It’s double or triple that of other advanced countries. People who really need them can get licit opioids in the United States.

And the drugs still killed 46 people a day in 2016, according to the CDC.

In any case, alleged unintended consequences of justifiable and, indeed, moderate public-health policies just do not belong in the same moral conversation as deliberate human rights violations such as police brutality or torture.

Article 12 of the International Covenant on Economic, Social and Cultural Rights does indeed exhort governments to guarantee the “highest attainable standard” of health; in that sense, there is a human right to health. Whether it can be defined with sufficient objectivity for this situation is another story. Assuring health is exactly what the CDC is trying to do — not through “regulations,” but through evidence-based recommendations.

To be sure, HRW acknowledges that opioids have been overprescribed in the past, in part due to deceptive industry marketing; a key focus of its current research is ensuring non-opioid alternatives for patients weaned off the drugs, Lohmann told me.

 

One ought not to prejudge the HRW report, due later this year, even if Lohmann’s comments to the Pain News Network implied that the CDC is blameworthy, and even if the organization funding the study, the U.S. Cancer Pain Relief Committee, is headed by a five-member board of pain specialists who are well-known advocates of opioid use for chronic non-cancer pain.

Two of them, Russell Portenoy and Richard Payne, have received financial support from opioid manufacturers. In late 2015, Payne spoke out against the CDC guidelines in a government advisory group’s deliberations before they were adopted. (Efforts to reach board members were unsuccessful.)

Note that the CDC guidelines specifically address opioid use for non-cancer pain only. The government encourages palliative care for cancer and hospice patients.

The U.S. Cancer Pain Relief Committee has previously underwritten HRW reports on the developing world, the theme of which is that AIDS and cancer patients are being denied access to morphine due to international and national rules intended to prevent opioid misuse. Palliative care in poor countries is a legitimate concern — among the many urgent health-care deficits that such countries face.

Here’s another legitimate concern: Poor and middle-income countries may be vulnerable to the same kind of pro-opioid campaign that wreaked such havoc in the United States.

Mundipharma, a network of companies controlled by the same closely held family business that introduced Purdue Pharma’s OxyContin to the United States, is engaged in aggressive opioid marketing in China, Colombia, Egypt, Mexico and the Phillipines, according to a recent Los Angeles Times report.

As Keith Humphreys, Jonathan P. Caulkins and Vanda Felbab-Brown write in the May/June issue of Foreign Affairs, the U.S. experience shows that “legal drugs pushed by corporations can bring death on a scale vastly surpassing the effects of illegal ones.” And no human right is more important than the right to live.

4 Responses

  1. I have been a pain management patient for 23 years. I will not even state my health issues as they are irrelevant to what is happenning to non cancer lifetime pain generation and appropriate management thereto. I CAN give testimony, backed by documentation at my current pain management “specialist”, one of two for 23 years as to how the CDC “guideline” forced my doctor tp reduce my medication that was benefitting me to the point that I have been able to enjoy my right to remain self sufficient, self providing for the last 7 years. One issue that really bothers me is the CDC making life saving OR life threatening decisions “behind closed doors”. At 59 years old now, unemployed since early 2016 with CDC guidelines I do not have any other means to lower generated pain short of alcohol use to the point of intoxication, seek cannabis use relief which is not legal in my state for any purpose short of a very few medical uses, or seek illicit substances which are both illegal and not regulated in “quality”…..period. We have to have a means to manage pain to a tolerable level which is subjective to each individual patients’ effective needs which in its’ self negates a blanket or nationwide maximum dosage of opioid medications for pain management. To me, the CDC enforced by the DEA “guideline” is a very basic human rights violation especially when documentation of opioid medication use only proves that an individual patient, the majority by far of medication users neither become addicted or abuse their personally, tailored dosage of opioid medication in whatever form has been nothing but beneficial to achieve basic function in life to an ongoing career with our doctors due diligence used in opioid medication prescribing. In short, the CDC guideline IS more harmful in effect than slowing drug/substance abuse.Is this fact caused by DEA? What I DO know in my small world is that the CDC guideline is causing previous best function in life to be severely impacted even among the “least” of .patients in non correctable, non cancer, lifetime pain management caused by injury, injury corrected surgeries, and pain generating diseases.

  2. I also wanted to mention: Did you notice you can email the author? That rarely happens!

    SO, IF EVERYONE WHO READS THIS ARTICLE WOULD EMAIL CHARLES LANE AND BOMBARD HIM WITH INFORMATION ABOUT WHAT THE GOV’T HAS DONE TO US, WE COULD GET THE ATTENTION OF THE PRESIDENT AND CONGRESS WHO READ THIS NEWSPAPER!!!

    The fact that the CDC guidelines were only that, NOT regulations and we’re only for primary care physician NOT ONCOLOGISTS or Pain Dr.’s. The DEA started suing any Dr. with assets, taking away their licenses and jailing them sometimes for decades, which then turned into Dr.’s abandoning their patients. That pharmacies/pharmacists can override a Dr.’s script, that insurance companies/Medicare/Medicaid won’t pay for the pain relievers. That the CDC made rules to limit the dose to 90MMED which makes it impossible for pain patients to work or take care of themselves. That now the DEA is proposing quotas (limits) on all Scheduled drugs after cutting manufacturing 3 years in a row (45%) reduction.

    You get the idea. Please do it everyone! The Washington Post is the 2nd largest newspaper after the New York Times.

  3. I told Terry McCoy (another Washington Post reporter) about the HWR investigation but he was more interested in doing a story about pain patients having to drive long distances to get their meds (another important story), but this was the bigger story that I pushed him to write about. He said he might do it later. Looks like he blew his chance.

    He’s a nice guy and I wish he had done it because I was telling him as much as I could rattle off about the background of Kolodny/Ballantyne and their conflict of interest, plus how the CDC falsely calculated their statistics and met secretly with no input from anyone regarding pain, etc. I told him how many CPP’S were commiting suicide plus VA refusing pain relievers to our brave men and women. I gave him things to Google and told him Pharmacist Steve was the best resource out there.

    I even hooked him up with our tireless, brilliant advocate Richard Lawhern, but it seems they had a short conversation because Terry’s focus was on his other story. I’m just relaying this because Charles Lane’s (author), perpetuated some of the falsehoods about opioids and if Terry had used my and Richard’s information, it would have been the story we’ve been praying the 2nd largest newspaper would print!

    Having said that, I’m grateful the author mentioned the HRW investigation. I even contacted Laura Mills from HWR and emailed all this information to her for which she was grateful. I am not trying to brag that “I” did this and that, I just want all of our chronic pain community to know that they can and should be contacting these people too (first get educated, and don’t go on about your personal stories—- just quote the facts ). Example: the Cochrane Report which states “less than 1% of people in moderate to severe pain get addicted.”

    Little pieces are getting out there, but contact the Big Boys of the MSM. You can Google their contacts.

  4. This always was about violations of basic human rights,,The U.N knew it,,and soo did HRW,,The U.N had a fund raiser for torture victums,and I can tell u,,HRW,,will help us,,legally,,Im not surprised at all,,this is about human rights,,it always was,,Hey the U.N tried to sit down w/.U.S.A..Gov…they refused to even come to the U.N to talk about this..The U.S.A,,gets what ever the deserve on this,,,for they have tortured to death sooo many innocent people and are torturing all of us,,Willfully,,I hope they all rot in a jail cell after HRW,,get done w/them,,,maryw

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