THE CLERGY FOR NEW DRUG POLICY
WEEKLY NEWS ROUND-UP
“Let justice roll down like waters.”
Amos 5:24
Dear Friends and Colleagues,
Pain resists words. We use stories, songs and poems to express great love but great pain finds its deepest expression in the screams and groans that aren’t words at all.
“To have great pain is to have certainty; to hear that another person has pain is to have doubt,” writes philosopher Elaine Scarry. The difficulty of expressing pain in words, as well as the often hidden nature of physical, emotional and spiritual pain can make it difficult to address.
Many people, especially chronic pain patients, understand what it is like to have pain dominate their lives while feeling that those around them are constantly questioning if the pain is real, and if it needs to be treated.
As I wrote in Addiction Nation, I had no problem managing the pain that came from putting a chainsaw into my leg, but acute necrotizing pancreatitis was different. It was the opioid-based pain medication that gave me even a slight breath of relief. I wrote:
The only moment that I remembered I was still a person—that pain was an experience I was having and not my entire existence—was the moment every fifteen minutes when I pressed a small button. That button sent a pump whirring and boosted the slow trickle of that blessed, blessed, blessed analgesic.
While I did develop an opioid use disorder, I might not have survived the pain of that condition without the drugs I was given. While I was lucky that my pain resolved after nine months, there are many others that deal with chronic pain for years.
Tragically, some of these chronic pain patients are dying by suicide after losing access to pain medicine that had been working for them. Dana Farber, one of the country’s leading cancer research institutes, is warning that even terminal patients are having difficulty accessing end-of-life pain management.
In the last newsletter, we covered a new report from the Cato institute about the dangers of politicians and law enforcement taking over the practice of medicine. This week, we want to highlight some additional stories of how that goes wrong.
The primary media narrative about the overdose crisis begins with the deceptive marketing of Purdue Pharma and overprescribing doctors. This led to a wave of addiction and then finally, overdoses.
But the real story is much more complicated. Purdue Pharma was criminally deceitful and many doctors subsequently underestimated the likelihood of addiction, especially among young people. But, roughly 75% of those who develop an opioid use disorder didn’t start with a doctor’s prescription but diverted drugs typically obtained through a friend, family member or dealer.
While there was some early correlation between the rise in opioid prescribing and opioid related overdoses, that has not been true for more than a decade (possibly two). In fact, overdoses skyrocketed after crackdowns on opioid prescribing as those who were addicted moved to more dangerous street drugs.
Drug policy and trends in the United States often bounce between extremes. From the false belief in a “non-addictive” opioid that made billions for those peddling a lie to draconian enforcement by the DEA that leaves doctors in fear of law enforcement and pain patients suffering.
The people who end up bearing the burden are the ones who are most vulnerable. Reducing the story of the overdose crisis to the actions of Big Pharma (as bad as they may have been) distracts from the ongoing driver of overdose deaths today, failed federal drug policy.
Keep the faith,
Timothy McMahan King
Senior Fellow, Clergy for a New Drug Policy
| Research and roundup compiled by Cassidy Willard, Research Associate |
Today’s nonmedical opioid users are not yesterday’s patients; implications of data indicating stable rates of nonmedical use and pain reliever use disorder
Most nonmedical opioid users are not yesterday’s patients.
High-dose opioid prescriptions (90 MME or greater) fell by 58% from 2008 to 2017, deaths involving opioids rose by 500% between 1999 and 2018.
Since 2010, deaths involving heroin and fentanyl have risen much more dramatically than those involving prescription opioids. In fact, “based on likely understated CDC data, fentanyl or heroin was involved in 75% of opioid-related deaths in 2017, up from 28% in 2010. Just 30% of opioid-related deaths involved prescription analgesics such as hydrocodone and oxycodone in 2017, down from 52% in 2010, and roughly 40% of those 2017 cases also involved heroin or fentanyl. In other words, approximately 18% of total opioid-related deaths in 2017 involved prescription analgesics without heroin or fentanyl.”
Sadly, the catastrophic nature of the current policies have been on full display in the last three months.
This Couple Died by Suicide After the DEA Shut Down Their Pain Doctor
On November 1, 2022, the DEA suspended Dr. David Bockoff, a chronic pain specialist, license to prescribe controlled substances such as opioids. The DEA has said that Bockoff received an “Immediate Suspension Order” which is warranted in cases where the agency believes the prescriber poses “an imminent danger to public health or safety.”
One of Bockoff’s patients was Danny Elliot, a 61-year-old chronic pain patient that was nearly electrocuted to death in 1991. Elliot struggled to keep a doctor, telling Vice that Bockoff was his third doctor to be shut down by the DEA since 2018. Elliott described “each transition meant weeks or months of desperate scrambling to find a replacement, plus excruciating withdrawals due to his physical dependence on opioids, followed by the return of that burning eyeball pit of despair.”
On November 8, 2022, after frantically trying to find another doctor to help him manage his chronic pain, Elliot and his wife died in a “dual suicide.” Elliot left behind a note that reads in part:
“I just can’t live with this severe pain anymore, and I don’t have any options left. There are millions of chronic pain patients suffering just like me because of the DEA. Nobody cares. I haven’t lived without some sort of pain and pain relief meds since 1998, and I considered suicide back then. My wife called 17 doctors this past week looking for some kind of help. The only doctor who agreed to see me refused to help in any way. What am I supposed to do?”
The DEA Shut Down a Pain Doctor. Now 3 People Are Dead
Tragedy struck again on December 10, 2022. Another Bockoff patient, 42-year-old Jessica Fujimaki, died. Many believe her cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. Fujimaki suffered from a rare disorder called arachnoiditis that causes debilitating pain characterized by severe stinging and burning pain and neurologic problems.
In a recent court filing by the DEA, lawyers argue that Bockoff’s patients only needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” and that “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs.
However, we know Detox and rehab will not help chronic pain patients. As Gretchen’s brother told Vice, “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.”
Judge Won’t Stop DEA Despite Patient Deaths
Tragedy struck again on December 10, 2022. Another Bockoff patient, 42-year-old Jessica Fujimaki, died. Many believe her cause of death was complications related to opioid withdrawal and medical conditions that caused severe chronic pain. Fujimaki suffered from a rare disorder called arachnoiditis that causes debilitating pain characterized by severe stinging and burning pain and neurologic problems.
In a recent court filing by the DEA, lawyers argue that Bockoff’s patients only needed treatment because of “his unsafe practices contributing to their opioid dependency and addiction,” and that “while it would be regrettable that Dr. Bockoff’s patients may face hardships,” there are other resources available, such as detox and rehab programs.
However, we know Detox and rehab will not help chronic pain patients. As Gretchen’s brother told Vice, “In my mind, what the DEA is essentially doing is telling a diabetic who’s been on insulin for 20 years that they no longer need insulin and they should be cured. They just don’t understand what chronic pain is.”
‘Entire Body Is Shaking’: Why Americans with Chronic Pain Are Dying
These stories of chronic pain sufferers who have killed themselves after losing access to opioid medication are not unique.
So, what happens now? How can we help chronic pain patients? Maia Szalavitz, addiction expert and journalist, has some ideas.
First, the surgeon general needs to make a strong national call for healthcare professionals to pay attention to the 2022 updated C.D.C guidelines for opioid prescribing. Doctors need to be warned that involuntary dose cuts for existing patients puts them at high overdose risk.
Second, the U.S. attorney general needs to tell the D.E.A. to stop perusing doctors solely because they prescribe high doses of opioids. Without other reason to believe there is criminal intent, it should not be an issue for law enforcement. If doctors are not providing a high level of care, it should be an issue for medical boards or an issue of civil malpractice.
Third, if the D.E.A. does discover criminal diversion of prescription opioids, great care should be taken to ensure that existing patients are not suddenly abandoned. Cutting off these prescriptions without support for those using them will only lead to more overdoses.
We cannot let more pain patients become the latest victims of the War on Drugs.