The Lincoln Plawg - the blog with footnotes

Politics and law from a British perspective (hence Politics LAW BloG): ''People who like this sort of thing...'' as the Great Man said

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Tuesday, November 30, 2004

A way to get the War on Drugs to stop?

(Or at least to dial it back a notch...)

Compare capital punishment: the moral case always has had, and for the foreseeable future, will have, no chance of bringing about abolition in the US. But regularly finding that guys on death row are in fact innocent does seem to make some pro-death penalty supporters at least consider whether a moratorium might be advisable.

There's no doubt about it: Joe Sixpack loves him some War on Drugs. And the nation's legislators act accordingly. (Some causality running the other way? Wash your mouth out!)

It's just possible, however, that he might be persuaded that a War that deprives a loved one of the pain relief he needs deserves to be rethought.

The Post today highlights the DEA's decision peremptorily to junk a set of guidelines [1] Prescription Pain Medications agreed after long consultation with medical specialists in the field of analgesia.

One is naturally sceptical that professional jealousy or myopia might be informing the hostile reaction to the DEA change of - I jest - heart. In this case, one suspects that these symptoms are to be found in much more virulent form in the agency.

The question is, How to harness this professional opposition [2] to political ends?

Sidebar: this is exactly the sort of issue (cf horse-race) story from which, to judge from their product, general political reporters (Wilgoren, Bumiller and Co) run a mile, despite evident tabloid news values. Ignorance and laziness amongst the journos play their part in this, no doubt; but, as ever, put the responsibility where it belongs: with the editors and management who choose to give issue stories the A17 treatment (November 17).

Coincidentally, today's Post piece ran on - A17.

  1. A 2MB PDF file.

  2. The Wisconsin University Pain & Policy Studies Group site has useful stuff. Its director, David Joranson, apparently led negotiations with the DEA on the now withdrawn guidelines. A general site on opioids has an earlier Post article on withdrawal of the DEA guidelines, and a NYT piece on a doctor, Frank Fisher, wrongly accused of dealing who did jail time before the Feds admitted their case was crap.

MORE (December 2)

Unsurprisingly, I find my suggestion has been anticipated!

For instance, in September, there was a briefing in the Capitol by the Association of American Physicians and Surgeons organised by Reps Ron Paul and John Conyers, which included a talk by Frank Fisher, the doctor mentioned above.

(The piece mentions a Dr Freddy Williams of Florida who apparently is serving a life sentence for what Fisher had been accused of.)

My impression is that the lobby is making no impression: the fear factor for legislators is just too great [1].

The medical judgement seems clear: for instance, a consensus statement endorsed by, amongst others, the AMA and the DEA, says
Undertreatment of pain is a serious problem in the United States, including pain among patients with chronic conditions and those who are critically ill or near death.

The AMA complains that
Unbalanced and misleading media coverage on the abuse of opioid analgesics not only perpetuates misconceptions about pain management; it also compromises the access to adequate pain relief sought by over 75 million Americans living with pain.

It seems that pols can agree - but only once they're out of office; for instance
"Untreated pain, tragically, is an epidemic in the United States," said Dr. Louis Sullivan, former Secretary of Health and Human Services...

What other lobbies can be brought to bear? Perhaps there's not enough in it for Big Pharma - but surely the AARP should be red hot on the issue, since the elderly are disproportionately prone to suffering chronic pain, and hence to need good pain control [2].

  1. The piece has some historical perspective, with a reference to
    the 1914 Harrison Narcotics Act, which early 20th century law enforcement used to arrest and prosecute thousands of doctors for the then-common practice of prescribing opiates for maintenance purposes to addicts. The law did not explicitly ban maintenance prescribing, but enforcement agencies claimed that such prescriptions went outside the realm of accepted medical practice and therefore violated the Act.
    There's also a 1953 Yale Law Journal article on the subject.

  2. A cursory glance at the site comes up empty.

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