End Discrimination Now issued a highly critical statement regarding the new prescription drugs laws approved this week by the NYS Senate. Characterizing the “new” law as “alarmist”, “excessive” and “incorrectly targeted”, END was particularly critical of Attorney General Eric Schneiderman who engineered a “highly political, if not personal” campaign using tax payer resources to create public alarm about an alleged “epidemic” of narcotic drug abuse where doctors are cast as villains and patients in need of pain care criminals. END President Kathryn Jordan stated that the attack on doctor and pharmacies was based on a “handful” of cases and a 1% conviction rate. There also was no support for targeting patients with real medical need for these drugs, instead of non-medical abuses and addicts. Apparently, Schneiderman and the Legislature held two secret “public” hearings where families of victims of overdose deaths, a single physician from Bronx Lebanon Hospital, the State Pharmacists Society , Walgreen’s Pharmacy, drug abuse organizations and several law enforcement representatives, including the DOH’s Bureau of Narcotics division testified. “The most important stakeholder group, the intended End User Patients for whom these drugs were designed, was not notified or represented. Further, extremely poor documentation of both the extent of the “epidemic” and the source of non-medical use was relied upon. END stated that the hearing was in violation of NYS Public Hearing Laws. “It cannot be a “public” hearing when the public is not notified or invited”. Jordan also stated that “myriad errors in characterization of drug safety and access” were propounded to gain acceptance by the NYS legislature. According to the CATO Institute, in their treatise “Treating Doctors as Drug Dealers”: “The government is waging an aggressive, intemperate, unjustified war on pain doctors....paint(ing) them as not healer so of the sick but suppliers of narcotics to degenerative addicts.”
More seriously, there appears to be an intentional manipulation of statistics to get support for the Bill. Citing a Newsday report as the source of his statistics (END could not find any hard data in that article), Mr. Schneiderman claims “22.5M prescriptions for all types of narcotic painkillers were written in the state in 2010, a 36 percent increase from 2007”. According to END, that’s only 9 percent a year, not an alarming statistic. “This is not to demean or diminish the fact that young people have shifted drug abuse habits to cheaper, more accessible drugs than cocaine or heroin. Nor is it a denial that drug overdose deaths are a serious problem that must be addressed by law enforcement. But it is a serious criticism of the lack of documentation of precise nature of the problem, the source of the problem, and the misapportioning of blame on doctors and pharmacies while stigmatizing patients who need these drugs for otherwise intolerable pain.”
Schneiderman used very aggressive claims in his campaign to secure support for the Drug Bill which END has demanded documentation of. Inflammatory concepts like “doctor shopping” which implicates the physician as the source of these drugs for non-medical use by addicts are rebutted by studies by the Substance Abuse and Health Administration where only 2% of medical users of narcotic drugs secured their medication from more than one doctor. In the new bill, Schneiderman repeatedly points the finger at the medical profession when only a handful of doctors have been arrested, much less convicted, of these crimes. “ Under our CURRENT NYS drug laws, Patients who use narcotic drugs have to produce triplicate original forms that are filed with the State. It’s virtually impossible to “shop” under these conditions”. END asserted. Additionally, a major study by the American Academy of Pain Medicine found that only 0.1% of physicians who were criminally charged were convicted, that’s one out of 954 over a period of eight years (1998-2006). “This has turned into a witch-hunt based on the arrest of a couple of doctors who are selling these drugs illegally. Our AG is using these poorly documented claims to wage a war on the profession and the pharmacies.” END predicts that the casualty of all of this Law will be that Patients who suffer from intolerable pain will endure “unnecessary suffering” and doctors will caught between “under prescribing” and not treating pain, and being targeted by overzealous prosecutors. “Physicians are a skittish community to begin with and Mr. Schneidman should know better than to use a sledge hammer when a surgical approach was needed. The problem is clearly not the doctors and it’s DEFINITELY not the patients who need these drugs to avoid intolerable pain. It’s the addiction community and the dealers.Where is the EVIDENCE that doctors are “dealing” these drugs to kids?" While the AG apparently relied on “Newsday” for its documentation, END argues that Quant Studies need to be done that prove where Non Medical users get their drugs before making onerous demands of the medical community.
Doctors should proscribe narcotics to people with addictive personalities and behaviors with great caution. END affirmed. Addicts will abuse any drug they can access and will always find replacements for the drugs that are “banned”. Obviously preventing young people from abusing drugs is a serious priority but one that can only be effected by parents setting the example, educating kids at an early age, and monitoring erratic conduct as they become young adults. A compelling statistic is that 25-66% (depending on the study) of those who died of pharmacological overdoses used opioids proscribed for someone else. “Kids are getting these drugs from friends, but obviously their friends have to have a dealer friend. Law enforcement should be focusing on that, not on doctors who legitimately proscribe pain medication.”.
Jordan also cautioned Law Enforcement about getting involved in “power struggles” in the medical community not just between hospitals and pharmacies but within the same. “There are doctors who really care about patients who endure severe pain, and there are those who are just political and want to score points with Law Enforcement who are indifferent to the suffering of patients”.
The new bill puts onerous demands on both doctors and pharmacies with demands for “new scripts” EVERY MONTH for every new narcotic drug, quarterly reporting, data bases that are guaranteed to violate patient privacy laws and a “patient is guilty” mentality that puts the doctor in the role of policeman. “This is overkill by a millionth power. It is using an elephant gun to kill an ant. If the AG cannot quietly prosecute these dealers and avoid all the drama, then they are doing something wrong”, Jordan argued. “This is intended to effect social engineering and to modify behavior so that it will be so onerous for doctors that they will abandon their pain patients. It’s barbaric”.
Jordan believes the current laws are so onerous that some doctors could avoid or stop proscribing pain medication. Further in the zeal to get this Bill out fast (and gain headlines) the Legislature has lumped all narcotics and pain relievers together, a serious mistake. “Drug addicts want “oxy” not “hydrocodone”. And adding Tramadol is ridiculous. It’s a very mild pain reliever that has virtually no “high”. Jordan stated. “This is opiophobia at its ugly worst, rooted in ignorance and imprecise definitions.”
END agrees with criminalizing the sale of controlled substances to minors under 14. However, she doubts it will stop abuse of narcotics. “Like most social problems, you have to precisely define who the target is and who is influencing the target, and how they gain access before you act. You need an education campaign. The media has made smoking and drug use “cool” and that has not helped. “
Nonetheless, END is more concerned about the “immense damage” that has and will be inflicted on patients. There are 100,000,000 Americans that experience chronic pain. “The harsh reality is that there are always going to be drugs around that kids can access. If we create a “witch hunt ”climate, instead of educating these kids and providing support on campuses, I predict they will turn to other channels. “ Jordan argued. The Center for Practical Bioethics in Missouri found that “The under treatment of pain is due in part to a kind of undesirable “chilling effect”. The concept…is a useful law enforcement tool. When publicity surrounding a righteous prosecution “chills related criminal conduct. However a chilling effect on the appropriate use of pain medication is not a public good. Recent research by Law Enforcement Roundtable confirms that prosecutions of doctors for diversions of prescription drugs are rare. But …over sensationalized stories of investigations of doctors have hit nightly news…and directly affects medical practice”. The consequence is that patients are deprived medication they need for quality of life and even survival.
Fortunately, there are protections. The Pain Relief Act protects physicians who proscribe pain medications from prosecutions and disciplinary action and patients’ rights to access pain medication. It does not protect doctors who fail to maintain adequate records or illegally divert medications for non-medical uses. “What this means is that there are already protections at the Federal level and NYS sponsors of this bill have duplicated many of these protections while attempting to subvert the purpose. I believe this new bill will be repeated or modified as a consequence in the future”, Jordan predicted.
