Over the past five months, I’ve noticed a disturbing trend on my Facebook feed. FB friends from across the continent have been reporting unusual events when they’ve gone to see a primary care physician.
Usually, I file such incidents under anecdotal reportage, but now there are too many for that. Plus, they follow what happened when my partner went to see her (now former) primary care doctor. The main detail these stories have in common is that they involve long-time patients prescribed opioids for chronic pain.
In each case, the doctors suddenly refused to reauthorize prescriptions for the opioids, accused their patients of being drug-seeking, then turned them away and referred them to pain care specialists.
Thanks to my partner’s devoted listenership to National Public Radio and the interviews they’ve conducted with Dr. Anthony Rostain, Cooper University Chief and Chair, Department of Psychiatry, and Jason Gibbons, health economist at the Colorado School of Public Health, I now know much about what’s driving this un-Hippocratic phenomenon. There are three visible parts: first, because of new DEA regs tightening access to opioids and the growing concern over their use, there is a nationwide trend of primary care physicians (PCP) referring pain patients to pain care specialists (PCS) and/or psychiatrists.
This has resulted in an unwelcome influx of patients for both, and they are usually forced to refer their patients back to their primary doctors. This then leads into the second part, where pharmaceutical companies cut back on making opioids, making them less available to those in need.
But the third piece is even more insidious and disturbing. A company called Bamboo Health has created a black-box algorithm (can’t be seen by pharmacists or anyone except its creator) that is supposed to be able to help law enforcement track down “pill mills” and patients who appear to be “drug-seeking.” The algorithm is used in a program called NarxCare, a name that should raise the hairs of anyone born in the 1950s and 1960s. It is an automated decision system. If the algorithm decides you’re a drug queen or a pill mill doc, that’s it. You’re cut off.
This is where the writer (yours truly) is obliged to say something like this: “I’m aware that there is a genuine opioid epidemic and that there are real deaths and real victims, and I wholeheartedly concur that those corporations who made a grotesque amount of money with these pills, while providing false data on their supposed benefits, need to be punished severely.” Given. But this program is the equivalent of treating dandruff by decapitation. For every genuine malingerer and pain mill doc you catch in the algorithm’s net, X number of conscientious medicos and patients with a legitimate need for these meds (despite the hype, they have their uses) are harmed.
In my partner’s case, because her PCP quit on her, she was forced to face quitting her pain and psych meds “cold turkey,” which, as any first-year medical student or addict could tell you, is a) a bad idea because b) it usually does more harm than good and c) does little or nothing to prevent recidivism.
This approach to combating the opioid epidemic is as ill-thought-out and harmful to patients’ rights as the War on Drugs. Even now, when it’s all but carved in stone that cannabis has medicinal benefits that have been repeatedly demonstrated in double-blind, controlled studies, there are still people sitting in prison, waiting for their lives to be restored for the “crime” of having loose joints or a dime bag of weed when the cops stopped them. As drug policy reformers like Eric Sterling, Dr. Arnold Trebach, Ethan Nadelmann, and Dana Beal have stressed repeatedly, you cannot treat drug abuse as a law enforcement problem.
In doing that, you spend decades ruining people’s lives and health while filling jails and prisons with overcapacity. It’s the same as destroying the village in order to save it. Many programs are in place to treat patients with drug addictions, and they need more money than ever. All the cops will do is buy more and bigger guns while maybe tossing a few pennies to crisis assessment teams. (And yes, I read that the Fullerton PD is putting CATs in place. It’s welcome, long overdue, and needs to continue.)
Whenever the federal government declares war on something–whether it’s poverty, cancer, or drugs–you have to look beyond the feel-good hyperbole to assess potential good and potential harm. And if harm is being done, reform is needed and must be put in place. Otherwise, what’s left is a bunch of deceptive jargon that fills law enforcement coffers while harming and killing people who need help.
What does this have to do with the homeless issue? Well, people experiencing homelessness are people, and some of them have debilitating pain. For instance, HUD estimates that approximately 10,395 California veterans are homeless, many of whom are suffering from pain.