The numbers are indeed alarming.
100 million Americans live with chronic pain. It is the most common cause of long-term disability in this country. Pain affects more people in the U.S. than diabetes, heart disease, and cancer combined.
According to the National Institutes of Health (NIH), this public health crisis costs society anywhere from $560 to $635 billion each, roughly $2,000 for each person living in the U.S.
Tremendous Costs of Pain
Beyond the fiscal restraints this crisis has on the nation’s health care system, it exacts a tremendous toll on the lives of those addicted to the opioids used to treat severe or chronic pain.
The NIH says there are two million people in this country with a substance abuse disorder involving prescription opioids. This disorder has claimed the lives of roughly 50,000 people from overdoses during each of the past two years.
These deaths, and the massive law enforcement and media attention given to what is now routinely referred to as the “opioid crisis,” have created a reluctance in the medical community to prescribe opioids. It is called the “chilling effect.” According to 2009 report by the Center for Practical Bioethics:
“The under-treatment of pain is due in part to a kind of undesirable ‘chilling effect.’ The concept of a chilling effect, generally, is a useful law enforcement tool. When publicity surrounding a righteous prosecution ‘chills’ related criminal conduct, that chilling effect is intended, appropriate, and a public good. Recent research by members of the Law Enforcement Roundtable confirms that prosecutions of doctors for diversion of prescription drugs are rare. But, on occasion, overly sensationalized stories of investigation of doctors have hit the nightly news. When that happens, the resulting chilling effect reaches far beyond a ‘good’ chilling effect on bad actors, and directly effects appropriate medical practice. The consequence is extreme, and not what law enforcement would ever seek – our parents and other loved ones who are in pain simply cannot get the medicines they need.”
Doctors in the Crosshairs Creates Chilling Effect
Much has changed since that 2009 report was issued. The DEA and the Justice Department are now increasingly going after physicians with an indiscriminate vengeance, especially when their patients die from overdosing on prescribed pain medications. An October 12, 2017 report of Cases Against Doctors is a 104-page listing of several hundred prosecutions of physicians nationwide.
In a February 17, 2016 Op-Ed piece for the New York Times, law professor and director of the Law and Health Care program at the University of Maryland’s Francis King Carey School of Law, Diane Hoffman, believes overzealous prosecutions of physicians has definitely had a negative chilling effect on the delivery of appropriate health care in this country.
Difficult Balance for Docs Treating Pain
“Undoubtedly, there are physicians who are bad actors and should be penalized for intentionally over prescribing opioids just to make money. But over the last decade and half, physicians have also been targeted by law enforcement agents when they were legitimately trying to treat chronic pain.
“Our law enforcement practices need to consider the dual goals of reducing drug addiction and abuse with physicians’ aims to adequately treat patients who suffer serious pain conditions, a group that includes up to 100 million Americans.
“Because the costs of erroneous actions are sweeping. Others with chronic pain suffer from the chilling effect such prosecutions have on other physicians.”
Physicians, and others in the medical community, must now deal with the fear of criminal liability when weighing how to treat patients with serious, long-term pain-inducing health problems. The situation has become so dire that, as Professor Hoffman pointed out, physicians must now think about even recommending the use of over-the-counter acetaminophen because some people can overdose “from many different drugs or extenuating circumstances.”
Doctors Get Tough Sentences
Physicians across the country are being prosecuted when drug enforcement investigators and prosecutors believe their prescription practices have resulted in death or harm. For example, in 2015, California physician Hsiu-Ying “Lisa” Tseng was convicted in a Los Angeles courtroom for murder over-prescribing pain medication and was sentenced to 30 years to life in prison.
Tony Yang, an associate professor of health administration and policy at George Mason University, conducted an analysis for the National Petitioner Data Bank that found the DEA penalized 88 doctors in 2011for their drug prescribing practices but by 2016 the number had increased fivefold to 479.
The so-called “opioid epidemic” has been so demonized that it has turned physician against physician.
Well Meaning, But Contributing
Dr. Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing has been quoted in media reports as saying: “The well-meaning doctors and dentists are the bigger part of our [opioid] problem. They’re inadvertently getting patients addicted, and they’re also stocking homes with highly addictive drugs.”
Aggressive investigative/prosecution tactics, combined with criticisms from within the medical community like those offered by Dr. Kolodny, toward prescribing opioid “painkillers” have many doctors delivering ‘defensive” health care under a paranoid-sieged environment.
Dr. Kimberly Curseen is a palliative care doctor at Emory Health care who works mostly with cancer patients. She told CNN this past July that she “acutely aware” of the target that law enforcement has placed on doctors.
“Personally, it’s very frightening … when you working with medications that are receiving this type of scrutiny.”
In effect, the DEA and the U.S. Justice Department, along with a host of state prosecutors, have effectively made pain a crime in this country.
President Donald Trump, in what was nothing more than a political grandstanding maneuver, recently said he was donating part of his salary to “combat the opioid epidemic.”
There is a genuine “opioid epidemic” in this country, but there is also a pain epidemic. There are 100 million chronic pain sufferers whose ranks are growing every single day. Each day in this country 10,000 baby-boomers are retiring, thousands of whom have serious health problems that cause severe or chronic pain. These are law-abiding citizens who have contributed immeasurably to the economic growth and technological advancement of our society over the past four decades. The DEA and the Justice Department would now make criminals out of them.
The real crime is to force the millions upon millions of Americans to live out their so-called “golden years” in chronic pain because the law enforcement community is terrorizing the medical community with overzealous prosecutions. Society has a legitimate right to expect that doctors-turned-drug dealers be held accountable, but the effort to find accountability for the bad actors should not make pain a crime and those who try to alleviate it criminals.