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The "Chilling Effect" of the Drug War on Pain Treatment John G. Chase, 09 October 2006
The problem The ACLU mission to protect citizens from their government has achieved major successes for previously beleaguered minorities. But there is one minority overlooked: chronic pain patients. Government antidrug policy is causing pain treating doctors to underprescribe or simply to quit, leaving their patients to fend for themselves. It has been a problem for many decades but has increased sharply after the introduction, in 1996, of the opioid painkiller, oxycodone, marketed by Purdue-Pharma, primarily as Oxycontin. By the late 1990s the media had begun to report deaths by painkillers, some legally prescribed, some "diverted" to the illegal market. Although the deaths were very few compared to what we now know about drugs such as Vioxx, DEA responded aggressively by prosecuting doctors who prescribe "too much". Since "too much" is undefined, doctors tend to undertreat, allowing their patients to suffer needlessly, with no end in sight.
History It is reminiscent of the alarm that followed the 1914 Harrison Act. All the Act required was that narcotics be obtained only from doctors who had registered under the Act. But the same prohibitionist fervor that led to National Prohibition allowed police to harass doctors who prescribed narcotics, and by 1922 most doctors had abandoned their patients. In 1925 the Supreme Court ruled unequivocally that doctors could legally prescribe narcotics to their addicted patients, even for self-administration.1 So after 1925 the Treasury Department chose only the most flagrant cases to prosecute, and most doctors took care to avoid scrutiny. These practices were finally tightened and codified in the Controlled Substances Act of 1970. Virtually all opioids are on its Schedule II; legal when prescribed by registered doctors within the "normal course of medical practice", but subject to criminal penalties if not. In the late 1980s, leading physicians began to recommend that opioid therapy not be limited to terminal patients, as had been the case for decades. This set the stage for today's collision between police and chronic pain treatment.
Chronic pain and high dose therapy For many chronic pain patients, flagrantly high doses are still too low. Chronic pain patients develop a tolerance that requires doses that would kill other patients. Jurors have difficulty believing that anyone would need a daily dose of opioid 200 times as large as the 5 milligrams they might use to tamp down a migraine headache. Jurors are easily persuaded that anyone prescribing that much is not "practicing medicine". High dosage has become the reason to investigate a doctor. But there really is no published criterion for "high". Even today the DEA advises doctors to read the case histories of prosecuted doctors to figure out for themselves what would invite DEA attention. DEA emphasizes that they prosecute only a " (Continued on page 6) |
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DMAC’s Role in Pinellas County Schools into the Future
The District Monitoring Advisory Committee (DMAC), the Citizen “watchdog” on Pinellas County’s 1971 school desegregation Order, was created to monitor the School District’s efforts to remove vestiges of school segregation from these activities and programs: * The allocation and improvement of Facilities and Resources * Hiring and Promotion of Administrative Staff and Faculty Recruitment * Student Assignment Transportation * Extracurricular Activities Quality of Education [“the Achievement Gap”]
DMAC’s membership is made up of one Black and one White representative from these organizations: North County NAACP; South County NAACP; Pinellas County Classroom Teachers Association; Pinellas County PTA Association; Pinellas Administrators Association and School Board. Meetings are held the last Thursday of each month and are open to the public. I was appointed as a School Board representative in October 2004.
Pinellas County has been operating since the 2003-04 school year under a “modified” choice plan which has expanded parents’ choices for assignment of students to schools while maintaining “caps” on the percentage of Black children attending any given school. This modified choice plan will be replaced in 2007-08 by a new student assignment plan currently being crafted by a Citizen’s Choice Task Force composed of representatives from the school district, its various organizations, churches, businesses, and community organizations. I represent DMAC on the Task Force.
The Supreme Court in the University of Michigan case recently decided that race was an acceptable factor to consider when making graduate school admission decisions. The Court will decide this year whether or not school districts can use race as a factor in assigning students in primary and secondary schools. The Task Force is trying to develop a program for student assignment which is legal, but will continue racial integration. We have studied the experience of other districts and recognize that we have a very difficult task before us in this county where racial minorities live in very discretely concentrated areas. The elongated nature of our geography further complicates the complexity of transportation issues which has historically fallen more heavily on black students whose families, like most in the district want their children to attend neighborhood schools, especially as elementary students.
Jonathan Kozol in Shame of the Nation points out that American schools are more segregated than at any time in history since 1954 (the year of Brown v. Board of Education…) and that the most segregated schools are found in New York, California and Michigan. Research on what happens to student achievement when schools resegregate are not promising. Please call me is you have comments or question about the Task Force, DMAC, or other information. Adrien Helm
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