In the latest episode of “Cops Practicing Medicine,” a floor vote is scheduled in the House of Representatives for H.R. 3878, sponsored by Rep. David McKinney, (R-WV). Under current law, drug makers and distributors are required to report to the Drug Enforcement Administration any suspicious orders for controlled substances. H.R. 3878 would also require them to perform “due diligence” on their suspicions, document and report their due diligence to the DEA, and refuse to fill the order if their suspicions are not resolved by the due diligence.
This amounts to the DEA commandeering the drug makers and distributors.
For the past ten years, the DEA and other policymakers effectuated a dramatic reduction in opioid prescribing only to see the overdose rate climb, as non‐medical users have switched to cheaper and more readily available heroin and fentanyl provided by the efficient black market.
The DEA has gradually tightened production quotas of injectable and non‐injectable opioids generating shortages of intravenous opioids during the COVID-19 pandemic, causing many hospitals to cancel or delay necessary procedures and jeopardizing the management of patients on ventilators, according to a July 22 report from the hospital policy group Premier.
This is not the first time that DEA opioid production quotas caused a critical shortage in hospitals. I wrote here about the shortage the agency helped create in 2018.
For the past several years, the DEA and drug task forces of local police departments have been intimidating health care practitioners into practicing pain management according to the edicts of law enforcement. State‐based prescription surveillance programs enable law enforcement to arrest and prosecute doctors that they believe are “overprescribing” opioids to their patients—even though there is no legal definition of “overprescribing.”
This has cast a chilling effect on prescribers, many of whom have resorted to forced rapid tapering of their chronic pain patients off of opioids, refusing to treat patients in pain, or undertreating both acute and chronic pain. Many patients now suffer, and in desperation, some turn to the black market or even to suicide for relief.
This regression toward a pre‐modern approach to the treatment of pain is based on a lack of understanding about the differences between physical dependency on a drug and substance use disorder (addiction). It is also based upon the refusal to recognize that, based upon the government’s own data, there is no correlation between prescription volume and the non‐medical use of prescription opioids or opioid use disorder among persons over age 12.
The Centers for Disease Control and Prevention reports a provisional overdose death rate of 76,092 for the past twelve months ending April 2020, of which 41,592 (54.6%) involved fentanyl and 13,898 (18%) involved heroin, 18,227 (24%) involved methamphetamine and other psychostimulants, 17,601 (23%) involved cocaine, and 12,180 (16%) involved prescription opioids.
So while the DEA persists in its intrusion into the practice of medicine, the overdose rate continues to rise as a result of drug prohibition and the deadly black market it creates.
In September 2019 the DEA reported on page 48172 of the Federal Register:
As a result of considering the extent of diversion, DEA notes that the quantity of FDA‐approved drug products that correlate to controlled substances in 2018 represents less than one percent of the total quantity of controlled substances distributed to retail purchasers.(emphasis added)
Therefore, it appears that diversion of prescription opioids into the black market is now a rare event. An obvious question then is where is the need for drug makers and distributors to join with cops in the practice of medicine?