Three recent actions by the Drug Enforcement Agency (DEA) will cause grave harm to pain patients. Rather than protecting the public, they will increase suffering as well as increase the rates of addiction and overdose death.
The DEA has a long history of raiding medical marijuana dispensaries in states where medical marijuana is legal. In one particularly egregious case in California, the DEA raided, at gunpoint, a medical marijuana dispensary which existed solely to supply terminally ill patients in an affiliated hospice. The DEA seized their drugs, increasing the patients’ suffering and in some cases hastening their deaths. The DEA also has prosecuted doctors who prescribe opioids for legitimate pain patients in the absence of any evidence they were violating standards of care or personally profiting from the sale of drugs. (See my book, The Truth About Chronic Pain Treatments for more information about this.)
In August 2016 the DEA declined to reclassify marijuana, a first step to making it legal and available to patients nationwide, despite pressure from patients, advocates and many policymakers to do so. Marijuana is a plant that grows in the wild worldwide in all but the coldest climates. It has been used medicinally for thousands of years. It was accepted as a medicine in the United States until antidrug zealots successfully campaigned to have it removed from the U.S. Pharmacopeia in 1941. Since then it has been classified as a Schedule I drug—a highly addictive drug with no accepted medical use.
Evidence has been growing for quite some time that marijuana is a safe and effective treatment for chronic pain. There is no lethal dose of marijuana, which in and of itself makes it preferable to opioids. States with medical marijuana laws have experienced, on average, a 25% reduction in opioid overdose deaths. Because many states and medical providers have now recognized marijuana’s value in treating many treatment-resistant conditions, including chronic pain, seizure disorder, multiple sclerosis and PTSD, many expected that the DEA would reclassify marijuana this year to Schedule II, drugs that have potential for abuse but also have medical value
This disappointing decision was followed shortly thereafter by the DEA’s decision to ban kratom, an Asian herb that many pain patients are finding helpful in managing their pain. Some patients have found that kratom helped them reduce or eliminate their use of opioids. The DEA justified its actions based on reports that a handful of kratom users had died during a two-year period after using kratom. In all cases, however, other substances were also being used by the people who died and may have been the culprit.
There was such a huge public outcry about the kratom ban that that the DEA took an unprecedented step and at least temporarily rescinded the ban in order to first hold public hearings. The final outcome is far from clear.
Then, on October 4, the DEA announced that it would sharply curtail the allowable production of opioid medications that can be sold in the U.S. in 2017. By the DEA’s order, the hydrocodone supply will be reduced by 34%, with most other opioids reduced by a minimum of 25%. The DEA justified its decision by stating that the number of prescriptions being written has decreased and it wished to reduce the excess supply that can fall into the wrong hands.
The DEA’s actions seem to have been taken with no consideration of their impact on pain patients. There are 100 million chronic pain patients in the U.S. and a very large percentage of them have been taking opioids to treat their pain for many years. Some have become addicted and most of the others have become physically dependent on opioids. Many patients are already reporting that as a result of the new CDC prescribing guidelines released in March, 2016 they are being abruptly taken off their opioids or having their opioids sharply reduced without any plan in place to help them cope with withdrawal or deal with their pain. The DEA’s most recent action will make this situation even worse, with the possibility that even when a doctor decides that opioids are the only viable option, patients may be unable to fill their prescriptions due to a lack of supply.
Medical marijuana has helped many patients reduce or eliminate their opioids, but most patients don’t have legal access to it, largely due to the DEA, or, even if they do, they can’t afford it because of a lack of insurance coverage. Most other pharmaceuticals have limited effectiveness and/or have serious or life-threatening side effects. Most patients also don’t have adequate access to safe, effective alternative pain treatments such as physical therapy, chiropractic care, psychotherapy, massage or acupuncture as a result of lack of insurance coverage.
The DEA is also pursuing this drastic reduction in prescription opioids without any increase in access to substance abuse treatment, the supply of which is woefully inadequate. Even the minimal $1.1 billion plan proposed by President Obama and passed by Congress has not been funded.
Many pain patients will suffer more and be less able to fulfill their work and family responsibilities due to the DEA’s actions. Many desperate pain patients will turn to the one thing that is in cheap, abundant supply—heroin and other street drugs. Isn’t this the opposite of what the DEA is trying to accomplish?
While the DEA’s overall goal of reducing opioid addiction and overdose deaths is laudable, it cannot succeed unless an infrastructure is in place that includes increased access to safe, effective pain treatments and increased access to substance abuse treatment. Let’s tell the new President to reform the DEA so that it focuses on drug cartels and leaves pain patients alone. Let’s also tell the new President to reform the healthcare system so that all patients have affordable to access to all safe and effective therapies.