The Current Hysteria

RAIDING PAIN CLINICS

December 4, 2007
Published at www.paincare.org
The National Foundation for the Treatment of Pain

The latest media blitz from law enforcement concerns the closing of “pill mills”. Great fanfare accompanies the news releases about clinics being shut down that “hand out hundreds of prescriptions for hydrocodone, Xanax and Soma.” The assertion is that “the streets are awash in these drugs and it’s the result of medically unnecessary prescribing by unprincipled doctors.”

Wait just a second, please.

The fact is that these clinics are supported by thousands of patients who simply cannot afford more extensive or sophisticated medical care. These patients are largely from the blue collar workforce. Because of the often brutally physical nature of their employments and long work histories from an early age, blue collar people are prone to very high incidences of structural damage, traumatic osteoarthritis, rheumatoid arthritis, late complications of injuries, spinal degeneration, and other stress-related somatic disorders.

They are often uninsured or under-insured. If they are workman comp patients they are typically abandoned by their insurers or so hassled by “case managers” that they have given up on trying to get comprehensive care with continuity of care-givers. All they can afford, typically, is the five minutes of attention, for $50 per month, that high volume, low-cost clinics provide.

These clinics must be high volume, in order to maintain fiscal viability. If they see 60 or 100 patients a day, at $50 each, they will gross $3,000 to $5,000 per day. By the standards of any sophisticated medical out-patient facility, this is “chump-change”. Such a clinic will have to employ a receptionist, a doctor, a physician’s assistant (or two), a nurse, a book-keeper and someone to do maintenance. With $3000 a month in rent, and insurance and utilities on top of salaries (plus unemployment security payments) such a clinic might net $20,000 a month, /before/ taxes. This is not high-dollar crime. This is low-income subsistence for a medical facility.

But, clinics like these are easy targets. Because of their necessary patient volume there are often substantial numbers of patients milling around waiting to be seen. Their cars are in the parking lot. The clinics’ names are boldly identified for the public to see. Often the medical personnel are foreign medical graduates, adding another element - racial profiling and prejudice - to their vulnerability to being targeted. The monotonous sameness of the minimal medical care they can afford to provide their blue-collar clientele (hydrocodone, Xanax and Soma) further dooms them to stereotypy. So, low

cost, high-volume clinics for the pain management of the blue-collar workforce easily become “pill mills” in the eyes of the authorities who really could care less about the poor people who frequent them.

The goal is to “get the drugs off the streets”. But what is actually accomplished is to drive all the blue collar patients into the streets, seeking relief from their suffering. Their choices become:

1. Score hydrocodone off the street
2. Score heroin off the street
3. Try to drown their pain with alcohol.

No one can tolerate unrelieved pain. It is simply not possible. So as long as there is a large profit to be made by supplying drugs to people who can’t get them legally, there will be a huge and flourishing black market on the streets. Closing the low cost pain clinics does not make the problem better; it makes it worse. Drug prohibition IS the engine that drives and supports the black market in drugs.

Only a VERY, VERY small percentage of all the people who buy illicit pain medications do so because they suffer an addictive disorder. At least 90 % are actually people in pain who in fact hate to have to use medication at all.

So where can they go after the police shut down their clinics? We all know where they have to go. So, whose side is law-enforcement actually on? We know what side L.E. "wants" to be on. But where does it actually end up? You know the answer.

The solution is to end opiophobia and fantasy-driven public policy. Establish publicly supported clinics so that every person who needs relief from suffering can get the same quality of care as those who have the financial means to see legitimate and skilled doctors. Demythologize medications and substance abuse. Treat the actually small numbers of people who have addictions with proper, effective medical care. Terminate the assignment of law enforcement to policing drugs (they can’t anyway, isn’t that abundantly obvious from fifty years of trying?) Confront the obvious fact that law enforcement, adjudication, prison and parole, are now totally strung out on the drug prohibition laws and need to be brought back to reality. Over half the 1 out of 21 people in America who are currently on federal parole or probation (that incidence was 1 out 51 in 1985) are in that situation because of non-violent, drug-related crimes.

We can no longer afford this historical folly. It is destroying the nation and creating a disaffected, crime-wise, cynical underclass of disenfranchised ex-felons whose numbers will soon inundate what is left of our society (if one includes those on state probation or parole, nearly every sixth person walking down the street is in trouble with the law and can’t vote.)

So wake up America. Time is running out and the dope lords are making billions. (the little “pain clinics” in the strip shopping centers sure aren’t.)

J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org


AFTERWORD
May 27, 2010

Three years later - and the current news is that we have spent 1 trillion dollars on the "War on Drugs" (almost 20% of our total current federal indebtedness). And the big news is that the push to "close down the pill mils" (Louisiana, Texas and Florida) is now hysterical.) why?

• Illicit drugs are more common, more abused, cheaper and purer than ever. Kids are over-dosing more often or greater combinations of drugs. Abuse of prescriptive medications has increased. Legitimate Pain is less frequently medically treated. Fewer doctors are willing to risk prescribing for pain. Even terminal cancer patients are more often dying in uncontrolled suffering. State Medical Boards have ramped up licensure and disciplinary actions related to opioids more than ever. The DEA budget is higher than ever. The incidence of imprisonment for non-violent, drug-related offenses is at an apogee.
• Unemployment remains double-digit as the current recession continues. The viability of the Gulf of Mexico is at imminent risk from a calamitous oil spill - caused by incompetence, greed and corner-cutting. Big money in the world markets continues to roil as the economic viability of Europe and perhaps the rest of the world hangs on a thin edge. Iran continues to develop its nuclear potential for weaponry. North Korea has just provoked South Korea in the worst incident in 55 years. Iraq continues to be an endless political and military morass exceeded only by Afghanistan. The U.S. Congress is a hopeless political stalemate - in which right-wing extremists threaten to take over the Republican party and accelerate its descent into a Whig-like demise. President Obama is demonized for not having solved the mess he inherited from eight years of Republican follies aided and abetted by lobbyist controlled Democratic congress people - wars, insolvency, illegal immigration, a catastrophically failed War on Drugs and its bizarre public policy hand-maiden, driven by hysteria and irrationality.
• The illegal drug market is now estimated to produce between 500 billion and a trillion dollars a year. There is a full blown war in Mexico over the control of drug money, which killed more people in 2009 than the entire total of U.S. soldiers killed in Iraq, from 2002 to the present. Mexican hit squads have invaded the United States and operate with impunity in every major city.
• The frustrations of the completely failed War on Drugs has created an unacknowledged strategy of turning on the helpless, and those who try to treat them, who are easy targets. Impotent to confront the Narco-tafficantes, and their superbly-funded and equipped armies, the Drug-warriors and their legislative sycophants, think they can conceal their emasculation behind this. And given the mindless gullibility of (to steal a phrase from H.L.Mencken) the "Boobus Americanus", it might just work for a couple more years of brain-dead Prohibition.

Given all this, is there any need to wonder why drugs have become such an integral part of the 21st century experience?

What is desperately needed is rationality, in every arena. What is right, rational and appropriate, must be given priority over what is most profitable. Money doesn't matter when the world has become lifeless and/or moribund.

In Florida, every single person who has had to go to a "pill mill" should join together to march on the legislature and DEMAND public funding of the legitimate care they need and threaten mayhem if the treatment of their pain is turned over to the Black Market.

One million people should march on Congress to demand the immediate repeal of Drug Prohibition and the War on Drugs. ALL the non-violent drug offenders should be immediately released and either pardoned or placed on probation, with the stipulation that if they descend into addiction again they are going into treatment for as many times and as long as it takes, to get their addictive disorders into remission. Hundreds of thousands must march on every state legislature to demand the same. The trillions being exsanguinated on policing, prosecution and incarceration of people with addictions must be redirected toward education, treatment, job-training, and the creation of vital economic development and growth. The billions being shoveled into the pockets of Mexican drug king-pins must be immediately terminated by eliminating their markets. Legalize domestic marijuana production, regulate and tax it (see Holland). Provide heroin at addiction clinics until the addicts can be effectively transitioned into treatment. Use whatever other drugs people want to abuse as inducements into the clinics that will treat them. (Want to sniff cocaine, drop downers, eat your Grandfather's OxyContin smoke a joint and drink Bacardi? Come on down to the clinic, We are eager to meet you and figure out what you really need. Hurry. It's free.)

JSH