Hydrocodone reclassification harms millions suffering from chronic pain
Nearly two years ago, the DEA made the lives of millions of Americans more difficult. On August 22, 2014, the agency moved hydrocodone combination drugs such as Vicodin from Schedule III to Schedule II. This reclassification created tougher rules, greater bureaucracy, stricter penalties, and a corrosive doctor-patient atmosphere for millions of Americans who suffer from chronic pain — many of whom are elderly, financially disadvantaged, or permanently disabled.
Chronic pain afflicts more than 25 million Americans according to the National Institutes of Health. Many of those people take narcotic analgesics, such as hydrocodone, to treat their pain and improve their daily lives. These prescription drugs bring relief to millions of people by reducing the burden of their pain. For many, the medicine means enjoying activities that would otherwise be excruciating. For others, it means being able to work a full-time job or being able to take care of loved ones. For all, it makes an otherwise painful existence a bit more bearable.
According to the DEA, the reclassification was aimed at “curbing this [opioid] misuse and abuse.” The Agency cited CDC reports indicating that in 2010 “seventy-five percent of the prescription drug overdose deaths (16,651 people) were due to opioid drugs primarily containing oxycodone, hydrocodone, or methadone.” However, these numbers do not distinguish between medical and recreational users. Many of those who died due to prescription drug overdose were not medically prescribed these drugs, but rather obtained them through theft or illegal purchase.
The DEA believes that they are only targeting pill mills and drug abusers, but these strict rules create artificial barriers for chronic pain patients and distort incentives for doctors and pharmacies. Under the new rules, prescriptions cannot be refilled, meaning that chronic pain patients must continuously return to the doctor for new prescriptions. The rules also place greater restrictions on distributors, which in turn reduces the total supply that pharmacies have available. This reduction in supply, coupled with the fact that pharmacies are often not allowed to tell patients over the phone if drugs are available, forces patients to drive to numerous locations before finding a facility that has their medicine in stock.
The new rules also generated a lot of alarm among pharmacists and doctors who fear investigation from the DEA. This can push doctors away from prescribing medication in favor of more expensive and risky physical procedures. Additionally, other guidelines foster medical environments to treat patients with suspicion. It is now routine for doctors to have patients with a recorded history of chronic pain urinate in a cup to prove that they are taking the medication and not selling it.
When the drug rescheduling was originally proposed, the American Medical Association came out strongly against it arguing that “the change may limit legitimate patient access to this medication.” They were right. Bureaucratic and administrative rules have serious costs. Every time a federal agency implements a new rule, it should ask itself if it’s doing more harm than good. Is the DEA protecting drug addicts or does it mainly serve as an impediment to those who are trying to find relief? In the case of the hydrocone regulation, the answer is clearly the latter.
Pain cannot be externally measured, but the number of deaths prevented can. It is much easier for the government to point to the statistical drop in the number of deaths caused by overdoses than it is to point to the amount of physical pain that has been relieved. There will always be a tendency to favor what can be externally measured over what is internally experienced, since the former can be seen by all and the latter cannot. Pain, however, is only directly observed by those it afflicts and is difficult to transport its gravity through language. In simple terms, it is easy to count bodies, and it is almost impossible to measure pain. However, that fact does not make the pain any less real.
The DEA does a great disservice to the millions of Americans who suffer from chronic pain when it ignores the barriers to pain relief that drug rescheduling creates. Regardless of the agency’s commitment to waging a War on Drugs, people who suffer from chronic pain should not have to suffer even more because of the combined actions of addicts and bureaucrats. Due to the negative effects that this policy has on millions of Americans, the DEA ought to reverse its scheduling decision on hydrocodone combination drugs.
Filed under: General Problems
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