Friday, 18 March 2011

Drug Hysteria & The Great Doctor Witch Hunt

 DOCTORS are writing thousands of suspect prescriptions for a pharmaceutical variation of heroin, much of it destined for the black market, forcing the federal government to investigate the actions of 50 medical practitioners.

The headline says, ‘Legal Heroin’. Seriously … Who writes this crap? OxyContin and MS-Contin are NOT a ‘pharmaceutical variation of heroin’. Heroin is a pharmaceutical variation of morphine. MS-Contin is just slow release morphine and OxyContin is similar except the active ingredient is oxycondone - a synthetic variation of morphine. 

Drug Hysteria 
It is this type of trash journalism that helps fuel the drug hysteria that we have become so accustom to. With help from the media, we have managed to demonise drugs to the point where the mere mention of heroin or amphetamines fills our head with images of needle littered alleyways infested with strung out junkies. We may not realise it but virtually no one alive today has experienced life without drug prohibition or the constant drum of anti-drug campaigns. Is it any wonder that so many people fear drugs without knowing the facts?

Since the 1970s, we have been bombarded with anti-drug propaganda courtesy of Richard Nixon’s “War on Drugs”. Not since the era of Reefer Madness and the Temperance movement had we seen such government vigour to demonise drugs. The US government’s commitment was so intense that it used all of it’s might to install their anti-drug policy on the whole world.  And just when we thought it couldn’t get any worse, along came Ronald Reagan. Any hope of rationality entering the drug debate was gone along with evidence based policy, human rights and logic. Reagan’s reign of terror introduced such doozies as mandatory sentencing, three strikes and you’re out, the crack-cocaine disparity laws and the “Just Say No” mindset. Damning drug users was now a permanent weapon for ambitious politicians, playing on the fear of parents and a gullible public. Conservatives, moralisers and the media went along for the ride. The US’s "War on Drugs" was now a global fight.

They say that the first victim of war is the truth. And the "War on Drugs" is no exception. When it comes to drugs, no claim is too outrageous and no strategy is off limits. Politicians and anti-drug groups are free to make any claim they want, regardless of the truth or reality. Drugs are now used as a tool to further someone’s career or push a certain ideology but the underlying message is fear. Luckily we now have the internet and a growing population who have used drugs recreationally and survived. The empty rhetoric from politicians - who openly admit to previous drug use but warn off others not to repeat their so called mistakes - is increasingly falling on deaf ears. Despite the predictions over the last 100 years of impending doom where drugged out zombies roam the streets or our hospitals are over flowing with dope smoking, paranoid schizophrenics, life goes on and the sky remains firmly in place. But the real issue that underpins the perceived drug problem is the specious strategies championed by the very people who keep making these dire predictions.

The Great Doctor Witch Hunt
My doctor has been telling me this for years - GPs are terrified of being targeted for over-prescribing opioids or benzos. He also told me that many GPs will under-prescribed much needed medications or not at all. They don’t feel good about it but sadly, fear is now a stronger incentive than best medical practice. My doctor is a pragmatic man and tells it like it is. he explains that moralisers, politicians and conservatives despise the misuse of drugs and if a few innocent doctors are wrongly charged, well it’s a small price to pay to catch those who feed the rabid junkie scourge. 

Human Services Minister Tanya Plibersek warned that doctors caught doing the wrong thing would be ``put on notice'' and face possible sanctions. The Professional Services Review could be called in, while serious fraud cases will be referred to the commonwealth director of public prosecutions, she said. 

This is a regular topic I discuss with my doctor  and he is as adamant as myself that the "War on Drugs" causes far more problems than it fixes. It’s probably ironic that during our conversation, he pauses to phone the health department to get an authorisation for my monthly script. A script that provides me with enough daily morphine to kill over 10 healthy adults. I always wonder while he attends his phone call if he is afraid of being targeted like the GPs he mentioned to me. If he is afraid, he has never shown it.

As part of a Medicare crackdown, 50 doctors across Australia have come under scrutiny for prescribing unusually high levels of drugs to patients aged under 50 who are less likely to need pain management medication.

When I hear about ‘prescribing unusually high levels of drugs’ I often wonder what doses are they talking about. How much is too high? As I previously mentioned, my daily requirements are huge compared to someone on 3 x 10mg tablets per day. But some pain sufferers take triple of what I am prescribed and methadone patients are often given twice my equivalent dose. It seems logical that some patients receive high doses to meet their medical needs whilst others suffice with a lower dose. My question is, how do bureaucrats determine the maximum level any one person needs to reduce pain?

I recently wrote about a situation in South Australia where DASSA (Drugs of Dependence Unit within Drug and Alcohol Services SA) have taken over the task of dealing with pain sufferers. DASSA’s main clientele are drug addicts and therefore lack the expertise to deal with pain patients who require large doses of pain medication. In typical bureaucratic style, DASSA has set upper limits on opioid dosages so that those who once had sufficient coverage for their pain issues now have to reduce their medication. Can we even imagine how much stress and suffering that causes those who are in chronic pain? Many of them can’t even get out of bed let alone attend a drug addiction centre like Waranilla at Norwood. While anyone else with a medical condition can see the doctor of their choice, those who need specialised pain management, must line up with methadone patients at drug addiction centres. 

Since the policy has changed many sufferers are now unable to work, care for themselves and their families, and are in constant pain. Things were working perfectly well before the policy change was made for no apparent reason

Tanya Plibersek
Bungled policies like the South Australian situation are a result of drug hysteria, political posturing and ignorance. But at what point does ignorance stop being an excuse for elected leaders who are paid to implement policies in the best interest of the community? And what about when a politician is not ignorant but still willing to rattle on with the usual “Tough on Drugs" rhetoric. 

The misuse of prescription narcotics is a growing problem that destroys lives and tears communities apart
--Tanya Plibersek

Human Services and Social Inclusion Minister, Tanya Plibersek has a good reason not to succumb to political pressure and repeating the standard government line on drugs. Her husband was once a drug addict and spent nearly three years in prison for a heroin distribution charge. If anyone should understand the futility of prohibition and tough law enforcement on drug addicts then Tanya Plibersek is it. 

You have to wonder if threatening doctors is really a sensible thing to do ... especially coming from Tanya Plibersek who should know better. There is already enough fear amongst medical practitioners who are reluctant to prescribe much needed pain medication. The insatiable desire to stop drug misuse is simply not balanced with providing important medication. Instilling fear into prescribing GPs does not help address the problem of drug abuse.

Maybe Tanya has never understood what a harrowing experience heroin addiction and prison really are? Tanya’s husband, Michael Coutts-Trotter and his heroin related problems ended two decades ago but since then, he has managed to become the Chief of Staff to the NSW Treasurer, Director-General of the NSW Department of Commerce and was appointed the Director-General of the NSW Department of Education and Training in 2007. An amazing recovery for a banged up junkie.

But it seems that her husband’s past has not managed to influence her present thinking. In January 2011, Tanya reinforced the government’s support of failed drug policies with an article in The Australian. Her attempt to appear appalled by the unethical spending habits of Australians was really a support piece for various government policies with criticism of those who are selfish and unethical in their decision making by contravening those policies. There was confirmation that the government’s internet filter would stop sickos viewing child abuse or violent sex, warnings of unfluoridated water harming our children’s teeth, praise for “the very successful national drug strategy” and even some finger wagging at those who buy expensive bottled water when they could drink some “good old five-star Sydney water”.

Many consumers think carefully about the ethical farming of veal, for example, but think nothing about the chain of misery and exploitation that brings them their Saturday night cocaine. Many Australians wouldn't eat foie gras because the practice of force-feeding geese is objectionable, but drug mules desperate enough to swallow condoms full of cocaine don't get a second thought.

The ABC reported in September that Mexico’s Sinaloa drug cartel is responsible for about half the cocaine importation in eastern Australia. More than 28,000 people have died in Mexico since 2006 as a result of the wars between rival drug cartels and law enforcement. The country is on the verge of collapse and brutal mass murders are becoming commonplace as drug lords vie with one another for lucrative control of regions.

Many of the so-called feelgood recreational drugs produced in Australia are made in circumstances in which violence is seen as a necessary tool in the process of production and distribution. The last person you bought from might be perfectly charming, but you can be almost certain that somewhere along the chain, violence and intimidation have occurred to bring you your drugs.

But where Tanya really went astray was with her attempt to cash in on the recently popular trend of blaming those who use “so-called feelgood recreational drugs” for feeding the violent drug cartels in Mexico. This, of course is ridiculous and more evidence of how prepared some politicians are to deceive us about drugs. And coming from Plibersek - who has living proof sharing the same bed - it’s even more diabolical. The fact is, drug cartels only exists for one reason … drug prohibition. It’s the very policies that bucket heads like Plibersek push that causes the 35,000 plus deaths in Mexico. If anyone is selfish and unethical in their decision making, it’s the bloody politicians.

Street Drugs vs. Pharmaceutical Drugs
The problem with heroin, cocaine and speed is that they are usually made by criminals in makeshift labs and passed down through various dealers who cut it at each stage. This means that the strength is unknown and full of god-knows-what. Pharmaceutical drugs though, are 100% pure with a known dosage. Some addicts will turn to Pharmaceutical drugs after a bad experience with street drugs or are wary of wasting more money on low quality gear. Surely, a better outcome in the spirit of harm minimisation.

There will always be people who inject drugs and there will always be people with narcotics dependencies. The positive advantage with OxyContin is that users know exactly what they're getting, whereas with heroin, they don't. Many now prefer OxyContin because it's clean and it's safer.

The pressing issue, as always is the law. If these drugs were prescribed to addicts in a controlled and clinical setting, there would be no diversion or over prescribing. We tend to forget that all drugs, including heroin, morphine and cocaine were once available to addicts as part of their treatment plan. They weren’t looked down on or stigmatised like today’s junkies. Most addicts worked, had families and lived like everyone else of the time. And the truly amazing fact is that since prohibition, we have spent trillions of dollars and sent millions of people to prison trying to stop drug use but addiction rates have remained the same. It seems that having hard drugs freely available via a doctor’s prescription yielded no more addicts than ruthlessly locking up those suffering from addiction. Armed with these facts, we, as a society should demand that politicians and law makers abide by the evidence and expert advice and stop this futile war on people. 

Legal 'Heroin' Sold To Addicts
Eamonn Duff and Daniel Lane
March 2011

DOCTORS are writing thousands of suspect prescriptions for a pharmaceutical variation of heroin, much of it destined for the black market, forcing the federal government to investigate the actions of 50 medical practitioners.

More than 580,000 taxpayer-funded scripts were approved in NSW in the past two years for OxyContin and similar opiate painkillers, such as OxyNorm and MS-Contin, dubbed ''hillbilly heroin''.

For every $34 script of OxyContin, users are obtaining a box of 20, 80 milligram tablets. Each tablet can then sell on the black market for as much as $50. With further subsidies to pensioners, the box can be bought for as little as $6 - and its contents might be sold on the street for $1000.

While the medication has revolutionised care for chronic pain sufferers, it is leaking out of the health system to such an extent that police and health experts warn it could soon surpass street heroin and ice as the needle addict's drug of choice.

The prescription opioids are obtained unlawfully by dealers and addicts who ''doctor shop'' for multiple prescriptions. One patient visited 46 doctors in three months and obtained 119 scripts, primarily for OxyContin, the government has confirmed.

Sydney doctor Alan Saunders, who has been targeted by doctor shoppers, warned: "It's not just OxyContin - it's valium and all the other drugs. The government is subsidising the drug trade."

Pharmacists say they are confronted with stolen and fake scripts, while legitimate pain sufferers are obtaining the drug and then selling it.

The government acknowledges the problem. Federal Minister for Human Services Tanya Plibersek confirmed to The Sun-Herald that Medicare had identified 50 doctors for ''unusually high levels of prescription writing for drugs such as OxyContin and OxyNorm''.

"The misuse of prescription narcotics is a growing problem which destroys lives and tears communities apart. Doctors suspected of making these drugs available to patients who do not require them for clinical purposes will be put on notice."

With a slow-release formula, OxyContin capsules are designed to work through the day. Illicit users, however, discard the other binding agents and extract the drug in its purest form so, when injected, it delivers an instant hit.

According to new state government statistics released to The Sun-Herald, more than $557 million worth of illegal drugs were seized in the state last year - more than double the street value of the previous year's tally of $260 million. The haul included $185.2 million worth of cannabis, $126 million of cocaine, $195 million of amphetamines and $28 million of MDMA/ecstasy. NSW Police Minister Michael Daley said the figures showed police were doing ''a fantastic job keeping our streets safe'', adding: ''It's millions of doses of deadly substances that have been kept out of the veins of would-be drug users.''

Significantly, NSW police also seized more than $25 million worth of heroin. At the same time, a taxpayer-funded version of the drug is infiltrating the black market. The commander of the NSW drug squad, Nick Bingham, said: ''We're talking pharmaceutical-grade heroin. It's highly sought after in the drug-using community and, unfortunately, it is finding its way [onto the streets]. To be honest, police don't particularly want to have to target prescription opiates when there are other important things to tackle, such as organised crime.''

Inspector Bingham is part of the recently formed National Pharmaceutical Misuse Strategy Committee and said prescription opiates were ''high on the agenda … One of the discussion points is educating doctors in regards to prescriptions … there needs to be tighter scrutiny.'' The director of the Alcohol and Drug Service at St Vincent's Hospital, Alex Wodak, agrees major reforms are needed to improve the way opiates are prescribed by the medical profession: ''The process needs to be far more discriminating, more realistic, more careful.

''GPs do the bulk of this work. They're under tremendous pressure and could do with better assistance from the whole system, whether it be from medicine doctors, psychiatrists, pain doctors or better guidelines tailored to them.''

Dr Wodak also referred to the ''long overdue'' national real-time database which, if implemented, could alert authorities when ''runners'' try to use multiple scripts at different chemists, at different locations.

''The Commonwealth seems interested in trying to get all the states to adopt a similar live system,'' he said. ''If we are serious about this issue, we have to form a national response.''

But Richard Mattick, from the National Drug and Alcohol Research Centre, fears a crackdown could hit genuine pain sufferers.

''Let's not forget these medications are terribly important to the community,'' he said. ''If you have a loved one affected by cancer or serious pain, you want them to receive the best possible care and these medications are much better, much safer than anything previously available. The community is better served and, in a way, that has allowed prescribing to be more generous.

''The danger here is that we see the bad side but don't balance that against the need.''

Gideon Warhaft, of the NSW Users & AIDS Association, argues: ''There will always be people who inject drugs and there will always be people with narcotics dependencies. The positive advantage with OxyContin is that users know exactly what they're getting, whereas with heroin, they don't. Many now prefer OxyContin because it's clean and it's safer.''

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Anonymous said...

Very well argued.

The Stig said...

Agree with anonymous, very well argued.

You’re showing some real insight into these complex issues Terry.

Keep up the good work.

Anonymous said...

I actually work in a pharmacy with a very high rate of opiod misuse. We have many immigrants from Afganistan paying $5.60 for 28 Oxy 80's every 3-4 Days. That 7-8 tabs a day! There is a very big drug trade out there, and if you dont think so, then you are not in touch with reality. This is not hysteria - this is reality. You just need to go to the western suburbs of Sydney and see for yourself.

Yummy Lisa said...

While it may be true that some doctors are identified as prescribing large amounts of opioid drugs, it doesn't mean that they are doing it illegitimately. No more so than a particular icecream parlor is more popular than another because they must be lacing it with something illegal. This problem has been with us for many years. The government could implement some changes but choose not to do so because it is profitable not to do so. If someone working in a pharmacy sees the same people over and over scoring drugs, they should report them. And my goodness, I have trouble with those frail elderly pain patients on every corner selling their wares. Wish I could find them because, sadly I now find myself in the predicament of feeling forced to take a drug that I feel will do me in fast. I already have fluid on my lungs and heart failure so want to be a bit careful in how I control the severe pain caused by incurable stage four terminal cancer. My doctor made me feel like an addict. When I asked for a refill of my prescriptions, originally prescribed by palliative care, she said NO!!!!! They are addictive. So as far as she is concerned I have no pain medication and she isnt giving me any, unless I take the drug of her choice, Fentanyl patches, I guess its cheaper. It is the weekend and I am very upset about all this. What has happened to my quality of life now? I want to end it all. What can I do? I am confined to bed, blind (due to a stroke during valvular replacent heart surgery) and dying of nsc lung cancer with uncontrolled pain. In March, the oncologist said I have about three months to live. I could care less how addictive it is. For Gods sake, Im dying here in utter agony. I find this unfair and ridiculous. Does my doctor need to be reported to someone? Can she insist I take a medicine I am not comfortable with? Is she allowed to just stop my medication because it is her opinion that the drug prescribed for me by Palliative care, oxycontin(codone) is addictive? I thought Fentanyl was even more addictive. She says it isnt. I dont think I will be able to manage the withdrawals after an abrupt end to the drug, never mind the pain. So I guess doctors are forbidding its sale to some people!!!! I dont know how much longer I can stand this.