NY Times Grasps the Inhumanity of Opioid Deprivation: A Decade Too Late

With few exceptions, the New York Times's coverage of the real story of the opioid crisis – too few pills, not too many – has been atrocious. The newspaper, for the most part, has been blathering the party line – that prescription opioids are driving the soaring overdose death toll. Even as late as 2017, when illicit fentanyl killed roughly twice as many people as prescription opioids we still saw inaccurate nonsense like this:

Overdoses, fueled by opioids, are the leading cause of death for Americans under 50 years old — killing roughly 64,000 people last year, more than guns or car accidents, and doing so at a pace faster than the H.I.V. epidemic did at its peak.

NY Times, 10/26/17

There have been scattered attempts to uncover the true story since then, but only last week did the paper publish a guest essay by Dr. Shravani Durbhakula, a Vanderbilt University anesthesiologist and pain management specialist, that hammered home how much damage the DEA has done to Americans who have done nothing wrong except become sick or injured.

But, what took so long? Let's look at the essay...

...starting with the title:

The D.E.A. Needs to Stay Out of Medicine (March 2024)

Dr. Jeffrey Singer and I (except where noted) have been warning about this for years. Some recent examples include:

• Bureaucrats are telling your doctor how to treat pain. And patients suffer needlessly. February, 2023 (Singer, Bloom, USA Today)
• Supreme Court Tells Cops To Stop Playing Doctor (Singer, Bloom, Reason, 2022)

In her essay, Dr. Durbhakula writes how neither she nor her husband – both physicians – were unable to obtain a sufficient amount of hydrocodone or oxycodone to treat the pain arising from her mother-in-law's pancreatic cancer, which had metastasized to her spine. [Emphasis added]

My mother-in-law’s 30-day prescriptions were filled with only enough medication to last a few days, and her care team required in-person visits for new scripts. Despite being riddled with painful tumors, she endured a tortuous cycle of uncertainty and travel, stressing her already immunocompromised body to secure her medications. 

 S. Durbhakula, M.D.

Any pain patient will tell you that the denial of pain medication is pervasive and pernicious, something I have written about as early as 2016 and as recently as 2024. Dr. Singer and I made this clear in the Philadelphia Inquirer in 2021:

• Pain patients are the casualties of the War on Drugs  (Bloom, Singer, Philadelphia Inquirer, 2021) 

And I have written about other cases:

• Merciless In Seattle: Untreated Pain, Misery, And Suicide (Bloom, ACSH, 2016)
• Death Without Pain: An Interview With Laurie Engel (Bloom, ACSH, 2024)

America’s new wave of fatalities is largely a result of the illicit market, specifically illicit fentanyl.

This has been well beyond obvious for many years. Here's one of many examples:

• It's The Fentanyl, Stupid. But Politicians Still Target Pain Pills. (Bloom, ACSH, 2020)

Paradoxically, the D.E.A.’s production cuts may drive patients to seek opioids on the illicit market, where access is easy but drugs are laced unpredictably with fentanyl, xylazine and other deadly synthetics.

This is an example of the "Iron Law of Prohibition" – the harder the enforcement the more dangerous the replacement drug will be. something Dr. Singer and I have written about a number of times, including:

• Government’s Fentanyl Crackdown Is Bound to Fail Like All Prohibitions Do (Singer, Bloom, Daily Beast, 2023)

We’ve seen this play out before: When the D.E.A. made legal access to products containing hydrocodone more difficult in 2014, the sale of opioids through online illicit markets increased to 13.7 percent of all drug sales from an estimated 6.7 percent, and sales shifted toward more potent opioids like fentanyl.

Yes, the rescheduling of hydrocodone from III to II was an early signal that drug policy was about to take a radical turn, and not for the better, something I wrote in 2013:

• New painful casualties of the drug war, (Bloom, New York Post, 2013)

"In theory, fewer opioids sold means fewer inappropriate scripts filled, which should curb the diversion of prescription opioids for illicit purposes and decrease overdose deaths — right? I can tell you from the front lines that that’s not quite right."

It has been obvious for years that all attempts to minimize the supply and/or availability of prescription opioids have cost lives, not saved them, something that Jeff Singer and I published, also in the Philadelphia Inquirer, in 2020:

• Misplaced blame for opioid epidemic harms pain patients  

[L]astly, the government should strip the D.E.A. of its authority to suspend providers’ controlled substance licenses when dangers arise and should hand that power over to these public health agencies.

Our government, specifically the DEA has become a malignant force, inserting itself between doctors and their patients, taking power and autonomy from both, something that was evident in 2017:

Opioid ‘crisis’ leading government to disrupt doctor-patient relationship (Bloom, Las Vegas Review-Journal, 2017)

Of all the issues that Dr. Durbhakula discussed, this is the most important. The DEA, which knows nothing about medicine, or pharmacology (1) (and precious little about drugs, ether) has acquired enormous power and the agency is wielding it like a sword, much like J. Edgar Hoover's FBI during prohibition. As bad as the 1920s FBI was, at least it was going after criminals. Now, the DEA is going after honest doctors who dare prescribe more than what is an arbitrary dose in the first place and targeting them as criminals.

The result? More pain, more death, the end of the doctor-patient relationship, and the ceding of our right to proper health care to a malevolent, rogue agency. Yes, the DEA needs to get the hell out of the business of human health. Now. 

NOTE:

(1) But Red Lawhern, Ph.D., an ACSH advisor knows plenty. Here is his published comment to the FDA from 2021: Comment from Richard Lawhern, Ph.D., Posted by the Food and Drug Administration on Jun 3, 2021