Thinking Citizen Blog — “The DEA (Drug Enforcement Administration) Should Stay Out of Medicine” (Dr, Sharvani Durbhakula, NYT)
Thinking Citizen Blog: Thursday is Health, Health Care, and Global Health Policy Day
Today’s Topic: “The DEA (Drug Enforcement Administration) Should Stay Out of Medicine” (Dr, Sharvani Durbhakula, NYT)
Is the federal government causing unspeakable pain to countless patients through the draconian policies of the Drug Enforcement Administration? So argues anesthesiologist Sharvani Durbhakula in an op-ed piece in the NYT. (The DEA is part of the Department of Justice. It was established in 1973 as part of the “war on drugs.” It is the “lead agency for domestic enforcement of the Controlled Substances Act of 1970. The DEA works with the FBI, the US Immigration Enforcement (ICE) and the US Customs and Border Protection (CBP) of the Department of Homeland Security,) “Our medical students report reservations about treating pain patients, and while a dedicated medical school pain curriculum can shift attitudes, few schools offer one. The number of unfilled pain medicine fellowship training positions has doubled in the past three years and pain physicians are leaving the specialty. For the field to recover, the thoughtful consideration of clinicians must be empowered by our nation’s health entities. It is time for the DEA to stop meddling in medicine.”
Today, a few more excerpts from the article. Experts — please chime in. Correct, elaborate, elucidate.
“SINCE 2015, THE DEA HAS DECREASED MANUFACTURING QUOTAS FOR OXYCODONE BY MORE THAN 60 PER CENT AND FOR HYDROCODONE BY ABOUT 72 PER CENT” — Wow!
1. “Despite thousands of public comments from concerned stakeholders, the agency has finalized even more reductions throughout 2024 for these drugs and other commonly prescribed prescription opiods.”
2. “As production cuts contribute to the reduction of the already strained supply of legal, regulated prescription opioids, drug shortages stand to affect the more than 50 million people suffering from chronic pain in more ways than at the pharmacy counter.”
3. “Doctors may be forced to ration medications or choose which patients out of a qualifying group receive scripts, and drug prices may increase for consumers. In an aging population with increasing pain medication needs, more patients may struggle more frequently to fill prescriptions that treat their pain, and because of known treatment biases in pain medicine, women and people of color could be disproportionately affected, widening existing disparities.”
NB: “Paradoxically, the DEA’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. My patients confide that they cannot go through cycles of pain relief and withdrawal and cannot spend hours in the emergency room; in their minds, they have no choice but turn to the streets.”
THE DEA IS A “SLEDGEHAMMER” — WHAT WE NEED IS “A SCALPEL” — what would the alternative be?
1. “Collaboratively, the Centers for Disease Control and Prevention, the Food and Drug Administration and the Department of Health and Human Services can take a tailored, more precise approach to opioids that is informed by medical and clinical acumen.”
2. “The FDA, in particular, should strengthen existing risk evaluation and mitigation strategies programs, which place controls on individual medications and respond to signs of inappropriate prescribing. Although such programs have not always responded effectively, they can be improved with planning, time, and resources.”
3. “And lastly the government should strip the DEA of its authority to suspend providers’ controlled substance licenses when dangers arise and should hand that power over to these public health agencies.”
THE STORY OF THE AUTHOR’S MOTHER IN LAW — “I’m still haunted by the fact that my husband and, both anesthesiologists and pain physicians who have made our life’s work to alleviate the suffering of those in pain, could not help her.”
1. “Even when her pancreatic cancer began to invade her spine in the summer of 2021, my mother-in-law maintained an image of grace, never letting her pain stop her from prioritizing the needs of others. Her appointment for a nerve block was a month away, but her pain medications enabled her to continue serving her community through her church. Until they didn’t.”
2. “Her medical condition quickly deteriorated, and her pain rapidly progressed. No one questioned that she needed opioid medications to live with dignity. But hydrocodone and then oxycodone became short at her usual pharmacy and then at two other pharmacies. My mother-in-laws 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.”
NB: “My mother-in-law’s anguish before she died in July 2022 mirrors the broader struggle of countless individuals grappling with pain….It is no wonder that our patients are frustrated. They do not understand why we, doctors whom they trust, send them on wild goose chases. They do not understand how pharmacies fail to provide medications they need to function. They do not understand why the system makes them feel like drug seekers.”
FINAL WORD: “The more laws, the less justice.” (Cicero)
Opinion | The D.E.A. Needs to Stay Out of Medicine
Drug Enforcement Administration — Wikipedia
Controlled Substances Act — Wikipedia
QUOTE OF THE MONTH
“Make your own Bible. Select and collect all the words and sentences that in all your readings have been to you like the blast of a trumpet.”
- Ralph Waldo Emerson
My spin — then periodically review, re-rank, and exchange your list with those you love. I call this the “Orion Exchange” because seven is about as many as any human can digest at a time. Game?
LAST FOUR YEARS OF POSTS ORGANIZED THEMATICALLY
ATTACHMENTS BELOW:
#1 A graphic guide to justice (9 metaphors on one page).
#2 “39 Songs, Prayers, and Poems: the Keys to the Hearts of Seven Billion People” — Adams House Senior Common Room Presentation, (11/17/20)
NB: Palestine Orion (Decision) — let’s exchange Orions, let’s find Rumi’s field (“Beyond all ideas of right and wrong, there is a field. Meet me there” Rumi, 13 century Persian Sufi mystic)
YOUR TURN
Please share the most interesting thing you learned in the last week related to health, health care or health care policy — the ethics, economics, politics, history….
Or the coolest, most important thing you learned in your life related to health are or health care policy that the rest of us may have missed.
Or just some random health-related fact that blew you away.
This is your chance to make some one’s day. Or to cement in your mind something really important you might otherwise forget. Or to think more deeply than you otherwise would about something that matters.
