“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
Do you remember all those wild fires in and around Los Angeles, Calf a few months back. Most of those fires were started from a spark, a camp fire, or other such things. Those fires torched some 90 sq miles. Just look at the CDC opioid dosing guidelines – as a spark – The VA quickly adopted, as did the DEA. Some 30 odd state legislatures condified those guidelines as the law in their state.
It took the CDC THREE YEARS to admit their mistakes, but here we are SIX YEARS later, has anyone seen any significant movement to undo the harm caused by those 2016 guidelines? Does this suggest that those behind the OPIOID PROHIBITION AGENDA have no intention of actually IGNORING THE FACTS that they are causing suffering and harm to untold tens of millions of our citizens.
The CDC did acknowledge that their 2016 opioid prescribing guidelines were misapplied. In April 2019, the CDC stated that its opioid guidelines had been widely misinterpreted and treated as hard and fast rules, rather than as flexible recommendations. The agency recognized that this misapplication led to unintended consequences and patient harm
The CDC acknowledged that the misinterpretation of their guidelines likely contributed to:
Untreated and undertreated pain
Serious withdrawal symptoms
Worsening pain outcomes
Psychological distress
Increased risk of overdose through use of illegal drugs
Suicidal ideation and behavior
The misapplication of the guidelines included:
Extension to patient populations not covered in the original guidelines (e.g., cancer and palliative care patients)
Rapid opioid tapers and abrupt discontinuation without patient collaboration
Rigid application of opioid dosage thresholds
Duration limits imposed by insurers and pharmacies
Patient dismissal and abandonment
In response to these issues, the CDC has since updated its guidelines to emphasize that the recommendations are voluntary and intended to be flexible to support individualized, patient-centered care
. The agency has also clarified that the dosage thresholds provided in the guidelines pertain solely to opioids used to treat chronic pain and are not intended for use in treating substance use disorders
It took CDC THREE YEARS to realize that the 2016 opioid dosing guidelines were a bad idea. I am sure that there are thousands of chronic pain pts that could have told them up front, before the ink had dried on the paper that they were written on, that they were a bad idea.
It took only a couple of weeks for 90 square miles to burn to the ground, but it is estimated that it is going to take 15 to 25 yrs for the whole area to get back to some sort of normalcy.
CDC causes patients to endure needless pain and suffering. Kennedy can help
The Centers for Disease Control and Prevention badly needs an overhaul, especially because of its undue influence on how doctors treat pain patients. Secretary Kennedy has the power to change this.
Not a month goes by without one or both of us receiving emails from desperate people pleading for help finding a physician willing to take new pain patients − a task that has become next to impossible.
Increasingly, these pleas are not just about pain management but about finding ways to end their lives, as years of forced reductions or complete discontinuation of the opioid painkillers that previously allowed them to function have left them bedridden, in constant severe pain or both.
Many have become “pain refugees,” seeking doctors who will accept new pain patients. These are not addicts seeking a fix; they are ordinary people who suffered an accident or serious illness. They once had full, productive lives but now face unimaginable agony.
Patients seek doctors who can help manage pain
Newly confirmed Health and Human Services Secretary Robert F. Kennedy Jr. has rightly called for a top-to-bottom reevaluation of U.S. public health agencies. One agency that badly needs an overhaul is the Centers for Disease Control and Prevention, especially because of its undue influence on how doctors treat pain patients.
In 2016, the CDC published a scientifically flawed opioid guideline built on weak evidence, misrepresented statistics and a fundamental misunderstanding of pain management with “suggested” opioid dosages. The CDC stressed that these guidelines are only recommendations, not “prescriptive.” Even so, when a government agency that people consider the premier authority on health matters makes a recommendation, it amounts to a de facto mandate.
By 2022, 40 states had enshrined the CDC’s 2016 guidelines into law. These state laws dictate the number of pills, their dosage and the duration that doctors can prescribe them. They impose restrictive opioid prescribing practices that undermine patient autonomy and substitute bureaucratic oversight for individualized medical decision-making.
Responding to criticism from scientists, physicians and patients, the CDC made minimal and meaningless changes to the guidelines in 2022.
Health practitioners who deviate from these restrictions do so at great risk − facing liability, regulatory scrutiny and even law enforcement action. Police department drug task forces may unfairly label doctors as “high prescribers” for treating patients requiring higher doses, leading to high-profile raids on their clinics.
Desperate, abandoned patients sometimes turn to street drugs, which adds to the toll of fentanyl overdoses.
Prescription painkillers aren’t the cause of opioid epidemic
The public, with help from the news media, still believes the myth that prescription painkillers are responsible for the overdose crisis. This is demonstrably false.
Prescribing peaked in 2012 and is now at 1993 levels – a reduction of about 50%.
Despite this, overdose deaths soared from approximately 40,000 in 2012 to 97,000 in 2024. Illicit fentanyl, often mixed with cocaine or methamphetamine, is almost always the culprit, not prescription pain pills.
The impact on the sick and powerless is staggering. One pain refugee cut off from medicine asked one of us if we knew how to test her street-bought pill − she took a small dose and vomited for 24 hours. A terminal cancer patient entered hospice, where doctors denied her oxycodone, causing pain and withdrawal. A mountain-climbing athlete was disabled by a serious accident and, now with brain cancer, sought advice on suicide due to unbearable nerve pain.
These are a few examples of the cruelty caused by the CDC’s misguided medical interference − an agony beyond most people’s comprehension. Even this tiny sample reveals the unimaginable torment caused by the CDC’s flawed foray into medicine.
Founded in 1946 as the Communicable Disease Center, the CDC’s mission was to stop the spread of communicable and infectious diseases. After helping eradicate malaria, which was endemic in the southern states, the CDC then tackled scourges like tuberculosis and smallpox.
Over the years, the agency has undergone mission creep, offering advice on many private health and lifestyle choices. An agency that takes on too many responsibilities can end up doing none of them well.
Fortunately, Secretary Kennedy can address this issue. In the spirit of compassion, we urge him to reform the CDC, restoring trust by ending its interference with patient-physician autonomy and refocusing on protecting lives from communicable diseases and public health threats.
Unwanted involvement from an agency that was never qualified to engage in personal medicine has caused unspeakable harm. Any one of us is one accident or illness away from facing the same fate − suffering that we wouldn’t allow for our pets.
There’s a growing problem for older Americans: doctors who specialize in geriatric care are dwindling.
More than 80 million Americans are expected to be older than 65 by 2050, according to the US Census Bureau.
However, geriatricians are in short supply, which could complicate access to care.
Jerry Gurwitz, a 68-year-old geriatrician based in Massachusetts, is at a tricky point in his career.
He’s spent decades taking care of older Americans, but now, as Gurwitz approaches the age of some of his own patients, he sees a brewing problem with his profession: there aren’t many people willing to take his job, and he has serious doubts over whether there will be enough doctors to properly take care of people as they get older, he told Business Insider.
Gurwitz, who graduated medical school in 1983, said he saw this problem brewing decades ago as he was completing his medical education. Part of the reason he chose to specialize in geriatric medicine was because practically comparatively few people were interested in the field, he said, a trend that hasn’t improved more than forty years later.
“These people are going to be retiring. There’s not substantial interest on the part of trainees to go into the field,” he said of the supply of geriatricians today. “I can’t see how the healthcare system isn’t going to be overwhelmed over the next decade. It’ll be too much, and too many people to take care of.”
Medical professionals say the problem has been in the making for years, with the supply of doctors trained specifically to treat older adults nowhere near keeping pace with a quickly aging US population.
There’s no clear path to addressing the shortage, Gurwitz said. He and other medical professionals told BI the influx of older patients could lead to a quality-of-care crisis.
The problem is visible in the numbers.
According to an estimate from the American Geriatrics Society, the US will need some 30,000 geriatricians by the end of the decade. Yet, the total number of board-certified geriatricians declined to around 7,400 in 2022, according to the American Board of Medical Specialities, down from around 10,000 at the start of the century —and the US population is quickly getting older.
According to the latest projections, the number of Americans aged 65 and older is expected to soar to 82 million by 2050, up 47% from 2022 levels.
Timothy Farrell, a geriatrician and a professor of medicine at the University of Utah, says the signs of strain on the profession have been increasing for years, but have become more severe recently.
Across the board, wait times have gotten longer, with the average wait for a physician appointment rising to 26 days, according to one 2022 survey, up 8% in five years.
“We could probably double our space, and we would very quickly fill,” Farrell said, adding that he believed stress in the geriatric unit could be higher than in other areas of the hospital.
R. Sean Morrison, a geriatrician at Mount Sinai, says he knows others in the industry who say they have waiting lists that stretch for six months.
The strain of caring for older adults is particularly evident in nursing homes. A survey of over 400 nursing homes conducted by the American Health Care Association found that 72% had fewer employees in 2024 than they did prior to the pandemic.
The survey also showed that 57% of nursing homes said they had a waiting list, 46% said they began to limit their intake of residents, and 7% said they were turning away patients on a daily basis.
“We don’t have right now, nor will we unfortunately ever have enough people who are trained,” Morrison said. “That’s evidenced by the amount of time it takes for an appointment within our geriatric practices. It’s evidenced by the number of older adults that need to be taken into the hospital that the inpatient services don’t have the capacity to see. And it’s just the tip of the iceberg.”
A dwindling medical profession
Gurwitz says he had always wanted to be a geriatrician, but the sentiment is rare among medical professionals. Data from the National Resident Matching Program showed that only 174 out of 419 available positions in geriatric specialty programs were filled in 2023, making it one of the most unfilled programs the organization tracks.
Convincing people to specialize in the field isn’t easy.
For one, the profession doesn’t pay as much as some specializations. According to data from Salary.com, the median salary for a geriatric physician in New York hovered around $264,163. That’s less than half the median salary of a cardiologist in New York, which stood at $573,498 a year as of March 1.
There is also a perception that geriatrics medicine is a less distinguishing field than other areas, Gurwitz said.
“I think there are certain fields of medicine that are more prestigious in which they are more respected than others. Geriatrics, for one reason or another, is not among those,” he added.
Farrell said he thinks that the complexity of treating older patients could be another factor turning professionals away from the trade. Geriatricians treat older adults who typically have overlapping health conditions, with some patients taking as many as 20 medications, he said.
“How do you prevent falls? How do you manage multiple chronic conditions for the same person?” he said. “I think there’s people in primary care who have more or less comfort with the complexity taking care of complicated, older adults, and that’s what geriatrician is trained to do.”
Hopelessness. Fear. Isolation. These are the feelings reflected in the stories we heard from people living with low back pain (LBP) who participated in two focus groups held by the Duke Clinical Research Institute These patients, members of our 300-person “Spine Squad,” volunteered to share their lived experiences with us.
Threading through the conversation was frustration with their doctors. These patients are not alone in their pain, and their experiences with physicians are not outliers.
LBP is the leading cause of years lived with disability worldwide and one of the most expensive conditions to treat. It is one of the top reasons why patients seek healthcare from both primary care physicians (PCPs), physiatrists, and spine surgeons. Most PCPs have little in their toolboxto directly address the needs of patients with LBP, but specialty care is also not the answer for many patients. Evidence supports the use of nonpharmacological (non-drug) care, including spinal manipulation, acupuncture, and exercise as first-line care. However, these treatments do not fall under the purview of PCPs or specialists, resulting in a significant disconnect between clinical practice guidelines and real-world patient care.
Neither providers nor patients are satisfied with the status quo. Doctors are frustrated because they have limited time to spend with patients, LBP is difficult to definitively diagnose, and effective medical treatments are elusive. Patients are frustrated because the treatments they try often do not work well and they feel unheard or misunderstood by the medical community.
Value-based care models emphasizing patient-centered approaches offer hope for change. In the meantime, we can improve how we approach LBP care now by focusing on these five things patients told us they need from their doctors.
To Feel Heard
“He acted like the pain was all in my head” and “All she wanted to talk about was my diabetes.”
Patients with low back pain want their concerns taken seriously, to feel that you, their provider, are listening, and that you respect their lived experience. They often feel ignored or dismissed by healthcare professionals. It is important to figure out what matters mostto the patient. Listen to their concerns and acknowledge their experiences and frustrations before talking about their other health issues, even if this means making another appointment. An empathetic, patient-centered approach will build trust.
To Understand the Cause of Their Pain
“They told me, ‘It’s just chronic pain.’ That isn’t a diagnosis. Something’s causing it, and I want to know what it is.”
Patients are searching for answers. Inherent in the biomedical model is the expectation of a diagnosis and a cure. This is one reason why PCPs order imaging — patients want proof that their pain is real and hope imaging will lead to a solution. Unfortunately, early MRIs and x-rays are rarely helpful. Ancillary findings or common conditions of aging can exacerbate fear-avoidance behavior. They can also increase the likelihood of unnecessary procedures and the transition from acute to chronic LBP. An alternative to consider is recommending several weeks of guideline-concordant non-drug care first.
Reassurance and Support
“The uncertainty of living with pain forever is worse than the pain itself.”
Chronic LBP often leads to social isolation, exacerbating other mental and emotional challenges. Patients crave reassurance that they’re not dealing with a life-threatening disease, that their pain won’t be permanent, and that they can maintain a fulfilling life despite their chronic pain. It is important to remember not only the actual words said, but also how they are said. Patients want clear information delivered in plain language with an empathetic tone. There is a difference between reassurance and casual dismissal of their lived experiences.
Access to Effective Treatment Options
“I just don’t know what to do next.”
The frustration patients feel with a casual dismissal is compounded by the often unclear treatment options presented. They want to know what treatments are most likely to help and how to access them. Good sources of information include the Lancet series on LBP and the American College of Physicians LBP guideline Providing education on first-line, non-drug treatments, along with appropriate referrals, can empower patients to take an active role in their health. This may lead to more positive outcomes as patients feel more involved in their healing process.
Care Coordination
“Doctors don’t talk to each other, so I have to piece together my own treatment plan.”
Patients can find themselves caught in a loop between their PCP and specialists. It is well known that lack of coordination in healthcare delivery can create confusion and delay effective treatment. It can also increase patient burden when patients are forced to develop their own treatment plans, navigating multiple prescriptions and sometimes conflicting physician advice without a clear sense of how everything fits together. This situation is particularly challenging for individuals with multiple chronic conditions. One solution is the use of multidisciplinary integrated pain management teams. Such teams are becoming more common and offer models for improving patient outcomes and fostering a more patient-centered approach.
We have much to gain by listening to the needs expressed by LBP patients. They remind us to pay greater attention to the power of the spoken word, offer reassurance whenever appropriate, and provide guidance on effective treatment options. We can also learn from new models of care, including multidisciplinary approaches and value-based options. While considerable work lies before us to optimize management and treatment for LBP, these initial steps can help transform the experience of those living with LBP, offering them relief from their physical symptoms and the respect they deserve.
When the CDC in 2016 created their version of opioid dosing guidelines, no one with any authority or visibility stood up and stated that the CDC did not have any statutory authority to create those guidelines and they had no statutory authority to cause any prescriber to follow those guidelines. Because they were JUST GUIDELINES, and the FDA has the statutory authority to create dosing guidelines FOR ALL Rx MEDICATIONS. Then 30 odd states’ legislatures decided to codify the CDC guidelines, which are not based on any clinical studies. Apparently, State medical licensing boards, pharmacy licensing boards, and/or any of the state boards that license various mid-level medical professionals pushed back.
It would seem that people who are attorneys seem like they operate under the saying, “no one is above the law… except those who are in charge of enforcing our laws”
Maybe someone needs to call this issue to the attention of Trump, Kennedy, and Musk. Maybe they need to look at defunding the DEA?
White House Press Secretary Karoline Leavitt strongly criticized recent rulings by federal judges ordering the reinstatement of thousands of probationary federal employees fired by the Trump administration. In a statement, she accused a “single judge” of attempting to “unconstitutionally seize the power of hiring and firing from the Executive Branch,” asserting that such authority belongs exclusively to the president. Leavitt emphasized that “singular district court judges cannot abuse the power of the judiciary to thwart the president’s agenda” and suggested that if judges wish to exercise executive powers, they should run for president themselves. She declared that the administration would “immediately fight back against this absurd and unconstitutional order”137.
The rulings, issued by judges in California and Maryland, challenge the administration’s mass firings of probationary employees across multiple federal agencies as part of its efforts to reduce government size. The judges argued that these terminations violated federal laws governing workforce reductions and were improperly directed by the Office of Personnel Management, which lacks statutory authority to fire employees in other agencies3910.
This video is from 1996, from an action taken by a Humana medical reviewer in 1987. Back then, many healthcare companies would call themselves Managed Care companies. Some out in the community often referred to these entities as “Mangled Care”. This video seems to explain why many within healthcare referred to some of these healthcare providers were referred to as mangled care.
Over 90% of independent pharmacy owners worry the program would severely hurt their finances, one survey reported.
Independent pharmacies are sounding the alarm on Medicare Part D’s drug price negotiation program.
The program, created under the 2022 Inflation Reduction Act (IRA), lets the Centers for Medicare and Medicaid Services (CMS) work with drugmakers to set lower costs for select Part D drugs in hopes of lowering healthcare costs for patients.
But up to 93.2% of independent pharmacy owners said they either will no longer carry Part D drugs or are considering not carrying them, as owners anticipate the negotiation program would “cause massive financial losses,” according to a survey of 8,000 pharmacy owners and managers conducted by the the National Community Pharmacists Association (NCPA), a trade group representing the nation’s roughly 19,000 independent pharmacies.
How it works. Under the current payment model, pharmacies pay drug wholesalers for medications, then pharmacy benefit managers (PBMs) reimburse the pharmacies a previously agreed-upon amount for each claim covered by a customer’s health insurance plan. It usually takes about 14 days for PBM reimbursement to reach pharmacies, according to Ronna Hauser, SVP of policy and pharmacy affairs at NCPA.
Under the new model, pharmacies will still pay wholesalers the same price to buy the drugs, but PBMs will reimburse pharmacies based on the updated negotiated prices, Hauser told Healthcare Brew. The negotiated drug prices are anywhere from 38% to 79% lower than the original list prices, according to the White House.
Drugmakers will then make up the difference. For example, if a pharmacy spends $500 to buy a drug, a PBM may pay the pharmacy $200, and then the drugmaker would reimburse the other $300 in the form of a manufacturer refund.
The new rules state drugmakers are required to reimburse pharmacies within 14 days of receiving confirmation that a prescription was dispensed to a Part D beneficiary, according to CMS. But pharmacy owners are concerned it will take longer as the new payment system gets set up, Hauser said.
In effect, pharmacies find themselves having “to float thousands of dollars every month waiting for refunds from the manufacturers,” NCPA CEO B. Douglas Hoey warned in a statement.
“I don’t have the cash flow or the financial stability to be able to ride those expensive drugs for that length of time,” Bill Osborn, president of independent pharmacy Osborn Drugs in Oklahoma, as well as president of the Oklahoma Pharmacists Association, told Healthcare Brew. “My question is, why are they not charging us up front the rebate price? Why are they making us carry it when we are the least financially viable?”
Osborn, who used to serve as NCPA’s president, is among those considering not stocking Part D drugs in his pharmacies, he said, which could lead to some patients in his community being unable to receive their prescriptions.
“It will be a hardship mostly on the patients because if they want to use us…they’ll have to find another place to get that one medicine,” Osborn said. “Hopefully they’ll stay with us, but that’s a risk.”
The financial effects. Part D drugs typically make up a significant portion of business for many independent pharmacies—about 35% on average for NCPA members, Hauser said.
If drugmakers reimbursed pharmacies seven days after the pharmacies receive their PBM reimbursements , pharmacies would have roughly $10,800 less cash on hand per week, according to a February analysis from healthcare consulting firm 3 Axis Advisors, commissioned by the NCPA. Annually, the analysis projected independent pharmacies could lose up to $46,475 in revenue.
Hauser said the NCPA and other pharmacy organizations have brought these concerns to CMS since the price negotiation program was first created in 2022. NCPA has asked CMS to freeze the program until they can find a way to implement it that wouldn’t cause financial hardship on pharmacies. While the agency has acknowledged the issues, it has claimed it doesn’t have the authority to change the IRA’s statutes, according to Hauser.
When asked for comment, CMS directed Healthcare Brew to a statement the agency released in January, saying it was “committed to incorporating lessons learned to date from the program and to considering opportunities to bring greater transparency in the negotiation program.”
Healthcare Brew reached out to several drugmakers with medications on the negotiated prices list that’s going into effect Jan. 1, 2026, but did not receive responses.
A broader implication. Approximately 10% of independent pharmacies in rural areas closed between 2013 and 2022, and Osborn said he’s concerned the new payment system will lead to even more closures.
“Here we are trying to maintain pharmacist access in rural environments, and now we’re going to make it to where it’s going to be even less accessible,” he said. “I worry about these rural locations that we could lose.”
Above is a link to a synopsis of the nearly 600-page agreement between 40+ state AGs and the three major drug wholesalers – who control about 80%-85% of all Rx med distribution to pharmacies. This agreement was not to see the light of day, and it took 1-1.5 yrs for someone to leak it. These 3 wholesalers agreed to restrict the number of controlled meds sold to pharmacies. There is no concern about the pts that have a valid medical necessity for some of these meds. Up front, these wholesalers don’t have a legal right to know what meds they sell to pharmacies and what patients are dispensed to. The questions that I have are this, 100 dose limit, a policy of the pharmacy, or multiple pharmacies have colluded to do this 100 dose limit. Did the 3 drug wholesalers in this agreement collude to impose this limit on all community pharmacies?
My opinion, one of the primary functions of the practice of medicine is the starting, changing, or stopping a pt’s therapy. Given that, any entity that is restricting the availability of any medications to pts, could be guilty of practicing medicine without a license. Could this rationing be a violation of the Interstate Commerce laws?
private pharmacies are being told. They cannot dispense more than 100 opioid pills to each patient. He had to call so many patients even if they are on palliative care this also applied to them.. i’m unclear where to try to address this I have given copies of the recent Illinois bill that was passed regarding opioids to see if someone would sponsor a similar bill, but I’m trying to figure out. Why would the private pharmacies be told they cannot dispense more than 100 opioid pills per month to each patient? this very kind young pharmacist had to call all of his customers and let them know they could no longer get more than 100 pills dispensed. And whoever told him this was how things had to be did not discriminate. It was across-the-board whether you’re on palliative care or not. The medical condition, diagnosis, terminal or not, the reason didn’t matter. 100 pills max.
For reducing illicit drug use, violence, or property crime, drug prohibition has been as unsuccessful as alcohol prohibition was for initiating Utopia. But as a method for propagating bureaucracy, it’s been wildly successful.
Albert Einstein never said, “Insanity is doing the same thing, expecting a different result.”
It was in 1981, long after Einstein’s death, that versions of the slogan first appeared in publications of the 12 Step groups Al-Anon and Narcotics Anonymous.
In sports and music, repetition is expected to yield different results. It’s called practice. Why wouldn’t participants work the steps again and again hoping for future success?
There’s another saying, so commonly believed to be first of the 12 Steps, it’s even used in ads for rehab facilities. “The First Step is admitting you have a problem.”
The actual Step 1 is, “We admitted we were powerless over alcohol and our lives have become unmanageable.” Admitting there’s a problem is a proactive approach. Admitting powerlessness and the inability to manage one’s life is defeatist.
We should ask what qualifies as failure and what “same thing” is being repeated. For decades, drug prohibition has become increasingly militarized. Ever-increasing resources go to police drug units, multijurisdictional projects, drug courts, incarcerating hundreds of thousands, and rehab facilities. Medical professionals have been deputized to prevent medications from being diverted for recreation or performance enhancement (e.g., steroids for bodybuilding, Ritalin for studying). Employers drug-test applicants and employees.
What would prohibition success look like? Probably not like ever-expanding encampments encircled by trash, human waste, and syringes, visible in many cities.
There are almost 200,000 people incarcerated at a time for drug offenses and defendants in every state diverted to drug courts. Every sizable community has agencies that connect residents with tax-funded rehab and multiple, free 12 Step meetings every day.
Except for the patent-owners ending Quaalude manufacture, illicit drug availability and demand persist.
Self-reported drug use counts among mitigating factors in criminal sentencing. Prison “drug education” leads to increased privileges and points toward early release. For federal inmates, a one-year sentence reduction for completing drug education is the only opportunity for time off.
Drug courts and rehab facilities actively protect clients from prosecution. Subsequent arrests are not the statistics these anti-drug institutions are looking for.
Work, a reasonable social life, and some drug use sound like an implausible lifestyle to modern ears. But count alcohol as mind-altering, and we’re describing over 80% of Americans. For decades after the Harrison Act of 1914, many medical professionals criticized the legislation because prosecution and criminal records would ruin the lives of otherwise functional people. There are actually data from federally funded studies. In the 1920s, over 800 self-identified addicts voluntarily participated in years of research. Subjects were examined in minute detail, from organ function to blood chemistry to excrement. There were a few results slightly out of range, as expected when numerous tests are performed on hundreds of healthy people. During these studies, before antibiotics, one subject contracted and survived pneumonia. Almost all the subjects were employed.
Sure, there are criminals who use drugs. Criminals also eat cheeseburgers, drive cars, and surf the internet. Criminals camp in public spaces using tents, tarps, and sleeping bags. If the government offered shorter sentences to defendants, and time off to inmates, for admitting that blue tarps caused their offenses, how quickly would reports surface linking tarp use and criminal acts?
Dedicated funding for drug enforcement, drug courts, and drug treatment does not coincide with a measurable decrease in availability or demand for illicit drugs, nor does spending on police in general. Increasing police resources does decrease crime that inflicts harm on others. A study by Princeton University Professor Steven Mello found that federal funding for 7,000 new police officers in 2009 led to substantial, measurable reductions of violent crime, larceny, auto theft, robbery, and murders, with no increase in arrest numbers and no spillover to other communities. Meanwhile, drugs are so available that inmate drug testing and positive results are routine.
Maybe we have no vision of what a drug war win would look like because there are too many people for whom the best possible situation is prohibition continued indefinitely. Thousands of bureaucrats have comfortable careers, air-conditioned offices and good retirement packages, and secure positions of power in the DEA, FBI, FDA, OCDETF, SAMSHA, NIMN, ONCDP, NIDA, etc., as well as similar agencies at the state level.
We know the first step: admitting the problem. Next would be dismantling policies not only that have failed, but for which there appears to be no template for success.
Here are some ideas that could be implemented at the same time as ending drug prohibition: 1. change self-administered intoxication from a mitigating factor to an aggravating factor in criminal sentencing; 2. stop using the word “criminals” as evidence of a link between drug use and crime; 3. divert all federal funding earmarked for drug enforcement to hiring more police; 4. take care of the seriously mentally ill, including long-term residential care, a priority.
Our Founders trusted us with deadly weapons, uncensored ideas, freedom to believe whatever we like and to associate with whom we choose. Attempts to restrict products with effects on mind, mood, or performance, inserted into the system designed to protect our freedoms, have not only failed to solve the problem they were adopted to address but have created a self-perpetuating system. The only consistent outcome of these restrictions has been the entrenchment of the thought-stopping cliché that we cannot just allow drug use.
America’s drug regulations rest on long-familiar, syllogism-like tendrils: Drugs are dangerous. Users can harm others. Laws target those who hurt people. Even if the drug war is unwinnable, punishing users who get caught creates deterrence. Ending prohibition is tantamount to full approval of nonstop drug-fueled debauchery. Nobody who abstains from entertainment or performance enhancement involving illicit chemicals should have any concerns about drug policy. Prohibition only targets antisocial troublemakers, who deserve what they get.
Oregon Ballot Measure 110, passed by voters in 2020 and enacted February 1, 2021, dropped Schedule I-IV drug violations from felonies to E misdemeanors, a $100 fine, and no jail. Oregon’s latest retreat from drug war orthodoxy follows legalization of recreational marijuana and medical marijuana, has not attracted federal retaliation.
Oregon has reduced punishment for non-medical possession to parking-ticket levels. But Oregon’s increased restrictions on prescription opioids, has gone in the direction much of the country has moved in recent years following the CDC’s lead.
Although the CDC pain guidelines and the OMB website both acknowledge that not all pain is controlled with 90 MME, the Oregon Medical Board, appointed by the governor, informed pain management doctors that all patients’ dosage must conform to the 2016 CDC Guidelines level of 90 MME (morphine milligram equivalents) by the end of 2021.
Anyone still prescribed above 90 MME in 2021 has meticulously-documented records of painful medical conditions and conforming to restrictions uniquely demanded of pain patients. The number of demands having lengthened over the years, is evidence of what kind of troublemakers these patients have never been.
Patients prescribed opiates are required to sign a document called a pain contract. Conditions can include being available for short-notice pill counts, urine tests (showing they haven’t sold the meds or used illegal or legal substances, from meth to tobacco to alcohol), mental health counseling if ordered, no prescriptions from another practitioner (e.g., a dentist after root canal), lost or stolen medications may not be replaced. While any violation is justification to immediately cease prescriptions, conforming doesn’t protect against abrupt cessation of prescriptions based on guidelines, not laws. There is no recourse, no appeals.
Americans facing charges or punishment for a felony or misdemeanor have multiple opportunities to derail the government’s goals. The accused may challenge the evidence, demand a jury trial, appeal the verdict, seek early release for good behavior, and request sentence commutation.
Oregon’s $100 drug fine can be waived by opting for a medical evaluation. If asked by the accused to perform the evaluation, a physician, with at least 11 years post-secondary education and 60 hours continuing education every 2 years, must refer the individual to an addiction counselor. The education required for counselor licenses range from Level One: 130 hours drug/alcohol education, 1000 hours supervised experience, and a high school diploma to Level Three: 3 years supervised practice, 300 hours education and a master’s degree (taking 9-36 months to complete).
An MD cannot perform what Measure 110 describes as a medical exam. That responsibility is given to someone with a fraction of the education.
Washington State has a similarly illogical mix of relaxed charges and punishments for drug possession outside of medical care and increasing harsh restriction on pain doctors and patients. After the State Supreme Court threw out Washington’s possession laws in early 2021, new legislation was quickly enacted making possession of Schedule I-IV drugs misdemeanors, with penalties expiring in two years. Although state Attorney General Bob Ferguson’s proposed new limits on opiate prescribing were not passed by the 2018 legislature, Washington’s state medical boards implemented those same restrictions in 2019.
Why are pain patients targeted for reduced medical treatment? Officials justify restricting prescriptions by reciting the numbers of deaths attributed to opiates — not dead pain patients, but all US deaths attributed to opiates (According to the CDC, among individuals whose deaths are attributed to opiates, 69.2-85.7% of their death certificates mention one or more other drugs, not including alcohol or nicotine).
One CDC publication of 2016 to 2020 data reported deaths of illegal synthetic opioid users rose from 8 to 11 per 100,000 population. Other opiate deaths remained consistently lower. From 2010 to 2020: heroin deaths were 4 per 100,000, methadone below 2 per 100,000 and prescribed opioids, 3.8 per 100,000. (For comparison, a 2020 CDC report puts lung cancer deaths at 34.8 per 100,000). Considering the thoroughly documented medical histories of opiate patients, one hopes a patient’s death would be fully investigated before being ascribed to medication. But, according to the CDC, only 8.5% of U.S. dead are autopsied. A report on opiate deaths published by the National Institutes of Health says there’s an error rate of 20-30% in the source data the CDC uses to compile and analyze mortality statistics.
The CDC’s own published data show prescribed opioids have been only a tiny factor in U.S. deaths, and the AMA reports restricting prescriptions by over 40% since 2011. Deaths reported have been rising only for illicit synthetic opioids, and not for prescribed opioids.
America’s first federal drug restriction, The 1914 Harrison Act, included within its text the promise that restrictions would never apply to medical, dental or veterinary professionals. In Oregon and Washington, prohibition is officially upside-down, with punishment eased for possession outside medical settings, while doctors face loss of livelihood and life savings, and patients suffer pain that could be treated but is not.
Punishing one for the infractions of another is the very definition of injustice.
Unconstitutional laws may be challenged in court. Elected officials can be removed by recall, vote or primary. But a citizen facing non-legislated guidelines wielded by unelected bureaucrats, is wrestling specters in the dark.
