America’s dramatic increase in prescription drug abuse has become an obvious problem over the last decade. America’s healthcare professionals, doctors, nurses, pharmacists and the like, saw this train wreck coming nearly two decades ago, but were powerless to stop it. As it stands today, the illegal use of prescription controlled substances among Americans is second only to the illegal use of marijuana. How did this happen?
To start with, we are physiologically programmed to enjoy a good buzz. Whether it is coffee, tobacco or alcohol, just about every person on the planet enjoys a little pick-me-up or slow-me-down on a daily basis. Rats like it, dogs like it, and people like it. Unlike rats and dogs, we are acutely aware of our own wiring and how to electrify it, and this sometimes has a tragically negative outcome.
Our brains are programmed to maintain a steady-state, like a boat gently floating on the ocean. Uppers make our boat fly for a while, and downers take our boat under water for a while, but always our boat, our brain, is programmed to return to sea level. If we try to make our brain fly forever by repeatedly taking uppers, and we do not allow the brain to return to sea level, our brain will actually raise the level of the sea to where the brain is. The same goes for downers. If you sink your brain for an extended period of time, your brain will make the sea level drop to wherever it is. Your brain becomes tolerant to your drug. It then needs the presence of the drug to feel normal and to remain at sea level. Once tolerance develops, if you remove your favorite drug, whether it be an upper or a downer, your brain will make you feel the opposite of every good feeling that drug ever brought to you. In spades! That is withdrawal. Did you ever get a pounding headache because you accidentally forgot your morning coffee? Now you understand. That is what caffeine, the most benign of the stimulants we use, can do with just modest, regular doses.
Human physiology divides people into two categories when it comes to addictive drugs – the addictive personality and the non-addictive personality. Drug dependence is divided in to two categories – physical dependence and psychological dependence. Drugs that are addictive are divided into two categories – ones with clinically significant uses and ones without clinically significant uses. We can argue all day long as to whether marijuana and heroin have clinical uses, but we will do that some other day.
The Original Problem
All reasonable people want legitimate patients to receive the medications they need to maintain as good a quality of life as possible. It does not matter if a cancer patient becomes physically dependent on narcotics. We have a moral obligation to control their pain. It does not matter that the autistic child becomes dependent on amphetamines if the drugs improve their day-to-day ability to interact with others.
All reasonable people also believe that using addictive drugs for nothing better than shits and giggles can pose unnecessary risks to the individual as well as society as large. Just about the only exceptions to this rule are alcohol and tea. It appears that very modest, non-abusive daily intake of these two has some small health benefits.
The crunch comes when you have a person who is prone to drug abuse, an addictive personality, who actually has a legitimate need for an addictive drug. How do health care practitioners differentiate between this patient’s legitimate need and their addiction? I have dealt with thousands of these patients over the last twenty-five years, and they will say and do absolutely anything to trick their prescribers and pharmacists into giving them “extra” so they can treat their condition and still get high on the side. They exhibit a very consistent set of character traits that are readily recognizable by practitioners. We can spot them coming a mile away and immediately go on the defensive as we wait for whatever convoluted story they have to tell while they beg for their preferred drug. I could write a book… and it would be both funny and pathetically sad.
How the Government Solved the Problem by Creating a Bigger Problem
About twenty years ago a bunch of left-wing, progressive do-gooders in government, folks who could not find their asses with both hands in broad daylight (like former Surgeon General Joycelyn Elders), decided that prescribers and pharmacists were grossly underserving addicts who also had real medical needs. We were discriminating against them. We were being “mean” to them. We were so tight-fisted in our approach that they were not getting the drugs they needed to control their basic condition, forcing them to shop doctors, pharmacies and emergency rooms, and then turn to illegal street drugs. The government said all of it was our fault! Doctors and pharmacists were turning good, law-abiding citizens into criminals. By the late 1990s the government forced health care providers to go through pain management training to make us more sensitive, and then forced us to loosen the purse strings and hand out addictive drugs to addicts just in case they had a legitimate medical need.
In doing this, the government substantially chilled the war on prescription drug addiction and abuse. Health care providers were suddenly like emasculated United Nations troops, deployed to keep the peace, yet not allowed to fire their weapons. The government was threatening our licenses to practiced medicine and pharmacy and addicts were given a platform to file malpractice lawsuits. The controlling legal authorities, each state’s board of pharmacy and board of medicine, the Drug Enforcement Agency, the Food and Drug Administration, etc. left us twisting in the wind. We could no longer look to law enforcement to protect us if we refused that questionable patient. That made controlling the addict extremely difficult.
It took only a few years for things to get out of hand. Corrupt prescribers and corrupt pharmacies took advantage of the government’s new approach, opening “pill mill” operations prescribing and selling controlled substances. Several times I complained to the DEA and several state boards about such practitioners and was given the silent treatment. So I gave up. I did what I could as a pharmacist to mitigate the problem, and I never knowingly filled a prescription that was not written for legitimate medical purposes. The trouble was, when I was suspicious of a patient or prescriber, I had nowhere to turn. The Oregon Board of Pharmacy turned their blind eye in 1998 when Oregon Attorney General Hardy Myers forced them to discontinued their monthly Drug Alert newsletter where pharmacists reported illegitimate prescriptions. I was involved in a DEA investigation of a pill-mill dentist who barely received a slap on the wrist after writing hundreds of narcotic prescriptions with no medical purpose. After that, my local DEA investigators sort of vanished. I have never had the Oregon Medical Board punish any doctor, even when they were trying to use my pharmacy as their own personal candy store (I kicked one SOB MD out of my shop so fast he did not know what hit him). There is a lot of dirt swept under the Oregon Medical Board’s rug. I currently have one pending complaint against a retired physician I caught forging prescriptions that the Board has done little to investigate.
The Government’s Solution to the Bigger Problem They Created
By 2010 things had gotten out of hand in all fifty states. Prescription drug addiction had become a multi-billion dollar industry. Drug manufacturers, prescribers, and pharmacies were making tons of money off of the sale of addictive drugs, much of which went immediately on the black market, and then were making tons of money treating the addicts for their addictions. The insurance industry was about to bust an artery, because it was footing the bill for a lot of it. Florida, a state know for its extremely permissive medical oversight, became ground zero for the new war on drugs.
In a schizophrenic about-face, government agencies like the DEA suddenly woke up to the problem of drug addiction they created across the United States. They began investigating prescribers and pharmacies in Florida with extreme prejudice. Giant (think wealthy) pharmacy chains like CVS were targeted, prosecuted and fined tens of millions of dollars for dispensing prescriptions that, while written by legal prescribers, were for no real medical purpose. The investigations spread like wildfire across the United States, even as the DEA was publicly denying the government’s culpability in the matter. Every state has instituted a Prescription Drug Monitoring Program where all pharmacies are required to report every controlled substance prescription into one massive database. Pharmacies and doctors are supposed to use this database to control patient use of controlled substances.
In response to the massive fines and government threats, pharmacies across the country clamped down hard on any and all suspicious behavior. If a prescriber cannot justify a patient’s controlled substance use, we will refuse to fill the prescription. If the prescriber is “pill mill” problem, we simply refuse all prescriptions from the office. There are no more “early refills” for patients with crazy excuses. Yes, a handful of legitimate patients have been inconvenienced and forced to stop overusing their medications, and a handful of doctors, PAs and NPs have had to reign in their addict patients, but that is just too damn bad. That is the effect $80,000,000 fines by the DEA have on pharmacies. Frankly, prescribers ought to be grateful for all the mistakes we clean up for them, and stop whining to the AMA. The government created a problem, prescribers enabled it, and the pharmacist is taking the blame. Now we are cleaning it up with a gun to our head while the DEA helps themselves to a windfall by rifling through our pockets. It is no different than a Central Park mugging. So man up, Doc, and be a team player.
Had any stupid, government do-gooder had the brains to ask me back in the late 1990s when this all started, I could have told them this is where we would end up. I was not even surprised when the government assigned blame where it did not truly belong. Since the 1960s we have been a nation of pill poppers. The government took the brakes off of a train that is perpetually going downhill and blamed the average American pharmacist when the train derailed and crashed. They are at fault. Republicans and Democrats, liberals and conservatives, they are all at fault. Every bureaucrat everywhere pulls this kind of crap every day and are never held accountable. Too bad the average American citizen cannot levy fines for the incompetence in government. Too bad we cannot put these idiots in jail.
So… now that you have slogged through this article… I want you to ask yourself a question. Do you still believe taking the brakes off of marijuana use and abuse will make America a better place? That is what our progressive society is currently doing. By first decriminalizing pot, then legalizing it for “medical purposes” we have radically increased the percentage of youth and adults who use and abuse marijuana for nothing better than shits and giggles. Mary Jane is number one in America, and our kids are driving high. THC, the chemical that makes pot worth smoking, is second only to alcohol when it comes to impaired driving, auto accidents and crash fatalities. Is that what you want?