Alexander DeLuca, M.D.
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Analysis of: "Federal Agencies Seek to Curb Abuse of Potent Painkillers"
by Anna Mathews & Gary Fields, WSJ, 12/3/2003

by Alexander DeLuca, 12/05/2003 in response to a question on the PAIN_CHEM_DEP listServ. Originally posted to 12/07/2003

Dr. X  wrote, referring to recent WSJ article posted on this List:

"I have read and re-read this article. Where is the problem?"

I don't believe I said there was a "problem" with the article, and there isn't beyond the usual parroting of DEA beliefs and nonsensical statistics as if they were accepted facts which justify federal actions against doctors which leads to the problem of under-treated pain in this country. This article is by far not the worst example of this sort of thing, but it is still easy to find paragraphs that cannot be rationally parsed.

Two examples from this particular journalistic effort:

Paragraph 1:

"Federal regulators are preparing plans to deal with the rising problems of abuse and addiction tied to powerful prescription painkillers."

I have yet to see any evidence that this country has a "rising problem of abuse and addiction" of any sort, but particularly one related to the treatment of pain. DAWN 'emergency room mentions' and the like without appropriate denominators, which are not proper rates, are at best suggestive and are not evidence of anything [except perhaps that federal law enforcement should not be in the biz of designing research-quality data collection programs :-)]

Alas, I can recall no journalist ever questioning this toxic little 'non-fact' so it forever repeated and has acquired a veneer of conventional wisdom (God help us all).

This is an insidious process. Eventually, apparently, even really crazy stuff becomes plausible in the public discourse -- for example, that Billy Hurwitz just might be a crack dealer after all and maybe we ought to keep him in jail just to be sure this "rising problem of abuse and addiction tied to powerful prescription painkillers," that have after all been tied to Billy Hurwitz, doesn't get even more out of hand. (Pardon the sarcasm)

Paragraph 10:

"At the same time, the agencies need to keep the drugs out of the hands of potential abusers. Last year, a federal survey estimated that 29.6 million people had at some point used painkillers without a medical need. An estimated 4.4 million had used one in the past month. About 1.9 million people had at some point used OxyContin without a medical need."

In the absence of an appropriate denominator, numbers like this, while not entirely meaningless, are very difficult to draw conclusions from. These are not proper rates, and therefore it is problematic to try and make these number say, "This problem is getting worse." But the DEA (and NIDA, and Leshner, and Bill Bennett, etc) repeatedly feed suggestive-but-garbage numbers at journalists who pass it on as if it actually meant something, as in the above quote.

Finally, 'use without medical need' is not, in and of itself, anything beyond bad judgment and certainly does not equate with "drug addiction" or anything else I can think of that could be used to justify a special federal interest superseding the States' right to regulate medicine.

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Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D., FASAM.

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Originally posted:  12/07/2003

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