The Ongoing War Against Pain Patients and Physicians

This complex issue has been developing since the Controlled Substances Act (CSA) of 1970 was signed into law by President Richard M. Nixon, as part of his declaration of the "War on Drugs". It classified all drugs with any psychoactivity into one of five "schedules", designated as C-I to C-V. Supposedly, and the way the legislation is written, the main criteria for placement of a compound into one of the five schedules are its utility as a medicinal agent and its "addiction liability".

Category
Description
Examples
C-I
This schedule contains drugs with the highest abuse potential that have no accepted medicinal value. No one is allowed to possess or prescribe these drugs, except in the performance of licensed research.
marijuana, heroin, methaqualone, mescaline, LSD, MDMA
C-II
High potential for abuse. Use may lead to severe physical or psychological dependence. Prescription must be written in ink, or typewritten and signed by the practitioner. No refills.
morphine, oxycodone, hydrocodone, amphetamines, barbiturates
C-III
Some potential for abuse. Use may lead to low-to-moderate physical dependence or high psychological dependence. Prescriptions may be oral or written. Up to 5 renewals are permitted within 6 months.
Marinol® (THC), steroids, codeine combo drugs
C-IV
Low potential for abuse. Use may lead to limited physical or psychological dependence. Prescriptions may be oral or written. Up to 5 renewals are permitted within 6 months.
benzodiazepines, weak barbiturates and stimulants
C-V
Subject to state and local regulation. Abuse potential is low; a prescription may not be required. IF permitted by state and local law, certain Schedule V products may be sold as "exempt narcotics" without a physician's order.
chloral hydrate, codeine cough syrups, buprenorphine
* APAP is a pharmacy abbreviation for acetaminophen (Tylenol®)

Here's a small linked Table of Contents to the remaining sections in this page.

Linked Contents Following
Legal Documents Articles Hypocrisy "Epidemic" Case

It takes only a little analysis of the above table to see some of the inconsistencies that confuse everyone involved, from the DEA to the end users (patients). For instance, marijuana is C-I, but its main active principle, THC, is only C-III. To me, this would be like scheduling opium poppies in C-I but having morphine be C-III. Pretty anti-intuitive, isn't it? Many chemicals have been placed on the schedule which possess no human activity whatsoever, but are precursors to controlled substances, so the DEA figured, evidently, that the easiest way to track them and arrest anyone possessing them, was to place them in the CSA, despite their not being drugs at all!

As each President has been elected, they have wanted to appear "tough on drugs", showering the DEA and NIDA (National Institute of Drug Abuse) with money to catch the evil drug users. Despite a multitude of evidence showing the value of treating drug addiction as a health issue rather than one of criminal activity, the US remains unique in the developed world in criminalizing the possession of small amounts of, for instance, marijuana. This has resulted in the US being the harshest jailer of its citizens, with 75% of Federal prisoners being there because of nonviolent drug possession.

Predictably, the great majority of people incarcerated due to drug possession charges are minorities - African-Americans, Hispanics, the poor, the mentally-challenged, etc. The DEA also likes to justify its existence by quoting the increasing numbers of adolescents who are entering treatment for "marijuana addiction". This is but an obvious effect of the drug courts that are sweeping the country as a solution to the perceived scourge of teenage pot use. Put yourself in a 17-year-old's position: A judge looks down at him, pronounces him guilty, and gives him the choice of going into treatment or to prison. Which would you choose?

The long-known medicinal activity of cannabis has been totally denied by the DEA, and most policy surrounding cannabis has its roots in the 1936 government-produced film "Reefer Madness", which has now become a cult favorite, especially on college campuses (never seen it? Here it is, all 68 min. of it!). Unfortunately, the hysteria engendered by this film and the atmosphere it created still rule the philosophy of Federal agencies, solidifying the idea that marijuana users (and, by extension, all other psychoactive drugs) are criminals.


Governmental Hypocrisy about Cannabis' Medicinal Effects

But here's a little-known fact the illustrates the hypocrisy of the government's position on marijuana and its supposed lack of medicinal activity. In 2003 - during the president of George W. Bush - patent #6,630.507 was awarded by the U.S. Patent Office covering certain medical benefits of cannabis. Want to guess who holds the patent? The U.S. Government! Check it out for yourself: http://patients4medicalmarijuana.wordpress.com/medical-use-of-cannabis-video/the-government-holds-a-patent-for-medical-marijuana/. The patent itself, on the official form, can be viewed here: http://www.patentstorm.us/patents/6630507.html. Adding to this was the "Compassionate Use Program", begun under President George H.W. Bush, which supplied certain patients with government-grown marijuana. Most have died, but there are still several patients who, every month, receive several hundred machine-rolled pot cigarettes. Right now!

The development of new drug therapies for chronic pain, including CRPS/RSD, which typically involve large quantities of opioids, set the DEA in motion again, this time using a two-pronged attack. First, they continue to arrest pain patients as users of illegal drugs (cannabis) or recognized drugs in large quantities, sometimes just for possessing the drugs which their doctor prescribed. Next, they make the rounds of pain management physicians, seemingly persecuting those who write for large quantities of opioids.

The first physician whose pursuit by the DEA became national news was Dr. Frank Fisher, a psychiatrist who was in charge of the psychiatric services of a hospice unit in CA. Many of his patients were in horrible pain from various sources, which he treated with morphine. The CA Medical Board decided to go after him, exhumed the bodies of his patients, and found lots of morphine in their blood (imagine that!). They promptly charged Dr. Fisher with five cases of first-degree murder! Several years later, Dr. Fisher had cleared his name and been found innocent of all charges. But then what? He lost his savings in legal fees, his reputation, and his practice.

Legal Documents

An excellent collection of documents covering all aspects of the "War on Drugs" is in the Erowid library; it's highly recommended for the curious or those wishing much more detail. Here are a few other official documents for your information:


Articles

As the consequences of this immoral war on sick people, many articles have appeared in the popular press, often written by investigative reporters who are very good at getting to the crux of an issue. Here is a selection of recent reports in the popular press showing the terrible effects of the "Drug War" on pain patients and their physicians; they're well worth your time:

starstarArticles Dissect the Panicky War on Rx-Opioids - a typically excellent commentary on the series of investigative stories published in Huffington Post, along with links to the three articles (these are listed in the last item in this list).

The DEA War on Chronic Pain Patients despite its name (DEAsucks.com), this is a well-researched and -summarized collection of articles showing the myriad problems caused by DEA drug prohibition.

Florida pain patients become collateral damage during war on drugs a short, succinct article on the same topic.

starHealth Special: Chronic Pain - a multi-part, meticulously-researched issue by Time magazine

How the War on Rx-Drugs Victimizes Pain Patients an excellent opinion piece from the superlative site Pain-topics.org.

Pain Management and Prescription Drugs from DrugWarFacts.org, a detailed analysis of the effects of DEA policies on drug availability.

starstarPatients are becoming collateral damage in US war on drugs from AlJazeera America, a very good, balanced discussion of the damage done to pain patients.

starReport: Chronic, Undertreated Pain Affects 116 Million Americans - an excellent piece from Time.com

starstarTreating Doctors as Drug Dealers - The DEA’s War on Prescription Painkillers - superlative, 28-pg paper on the ways the DEA persecutes and terrorizes pain management physicians.

starU.S. Drug Move Said to Deprive Elderly from the New York Times, a piece on the Congressional hearings about the rescheduling of hydrocodone products and the effect on the pain patient population, especially the elderly.

The ‘War on Drugs’ and Pain Patient Casualties an editorial in Pain Medicine News by a multiple-certified pain management specialist, showing how the supply of pain drugs for deserving patients has been crippled by the DEA.

starThe War on Drugs Becomes the War on Patients in Pain an editorial from an assisted living center, aware that rescheduling hydrocodone products from C-III to C-II would severely limit its accessibility, especially when needed quickly.

starstarstarThe War Over Prescription Painkillers a three-part story by investigative journalist Radley Balko for Huffington Post, important reading for anyone who relies on prescription medications to live comfortably: Part One - The War Over Prescription Painkillers; Part Two - The New Panic Over Prescription Painkillers; Part Three - Painkiller Access Debated as Patients Suffer.


Pure Hypocrisy - U.S. Government Research and Patents
on the Medicinal Activity of Cannabinoids

As we all know, the DEA's scheduling of marijuana in Schedule 1 (C-I) relies, in part, on their claim that there are no recognized medically beneficial effects from the plant. Meanwhile, the government continues with activities in direct opposition to this claim. Over the years, the US government, through the research in US laboratories such as those at the NIH or US-sponsored research at academic institutions, has been building a patent portfolio on the many and varied pharmacological benefits of the cannabinoids found in marijuana.

Under the presidency of George H.W. Bush, a "compassionate use program" was begun to supply patients whose conditions warranted the use of cannabis to ease their symptoms. About two dozen patients were accepted into this pilot program. This program continues today, although all but four of the original beneficiaries of this policies have died; of course, no one has been added to the list of fortunate few who were part of this initiative. One of these survivors has written an editorial to President Obama, asking if compassion will guide his future decisions about medical marijuana. The program was reviewed in 2002, indicating its unqualified success.

These patients receive their marijuana from the only licensed facility in the country to grow and distribute it to appropriate parties, located at the University of Mississippi. Users and others who have tried this product uniformly rate it as inferior grade, despite assurances from its director. He also claims that there is only one marijuana species, a falsehood easily disproved by any botany book and known to anyone familiar with marijuana.

There are growing numbers of articles in the popular press, discussing marijuana's beneficial effects. In fact, the title of a recent continuing education module for pharmacists was called "Medical Marijuana: Therapeutic Uses and Legal Status". It's also an excellent review of the situation, containing nearly 50 references.

Now, to a few patents and patent applications. This is just a small sample of the patents that exist, but gives a good idea of just how useless the government *really* considers marijuana as a medication, including the variety of conditions against which its efficacy is being measured.

Don't be fooled by the "Assignee" never listing "U.S. Government" - there is no part of the government that can hold such patents without the hypocrisy being completely transparent. Assignees are typically state university systems or small companies heavily underwritten by government funding, whose contracts specify certain things like patent ownership.

Patent No./Link
Issue Date
Title
6,800,770 10/5/2004 Anti-Spasticity of an Eicosanoid Compound
7,179,800 2/20/2007 Cannabinoids
2/27/2007
Keto Cannabinoids with Therapeutic Indications
2/5/2013 Cannabinoid Receptor Targeted Agent
8,377,985 2/19/2013 Treatment of Cancer
Patent Appl./Link
Publ. Date
Title
US2006/0084659 4/20/2006 Augmentation of Psychotherapy with
Cannabinoid Reuptake Inhibitors
US2009/0105128 4/23/2009 Cannabinoid Receptor Targeted Agent
US2010/0280118 4/4/2010 Methods for Treating Substance Dependence
US2011/0280807 11/17/2011 Methods and Models for Stress-Induced Analgesia
US2011/0124644 5/26/2011 Methods of Diagnosing and Characterizing
Cannabinoid Signaling in Chron's Disease

Publications Purporting to Show the "Epidemic" of Rx Drug Abuse

Many papers, articles, and other media have been extensively used to convince the public that a true epidemic of prescription drug abuse is happening right now in our country. Any possible reasons for any such problem are never offered, although pain physicians and patients alike blame the ever-tightening monitoring of controlled substance prescriptions, especially C-II drugs, by the DEA.

Following is just a selection of recent publications which claim to provide the data supporting ever-more-difficult access to legitimate C-II drugs, including those of us for whom access to good analgesics is necessary for life itself. No comments are needed - just choose one and check it out.


A Case Study - the Medical Marijuana Law in Illinois

in November 2013, Governor Pat Quinn signed the medical marijuana bill into law. Many logistics need to be worked out prior to MM patients being able to buy medical marijuana, but meanwhile, the drug warriors are doing their best to undermine the bill we worked so hard to get passed. Of direct relevance to those reading this, a group of drug warriors tried to attach an amendment that would remove CRPS/RSD from the list of indicated illnesses. This effort was defeated, but we expect them to raise the issue in the new legislative session.

For a couple of examples of the warriors' efforts, here's a flier advertising a presentation that three of them are traveling around, called "Truth and Consequences of Marijuana as Medicine - A fact-checked, research-based discussion about marijuana and Illinois." Also, here's a document by one of the warriors, who used to work for the drug czar in the Dubya administration, who shows us how the inclusion of CRPS/RSD will allow "non-ill persons" to use marijuana. It makes no difference how much science is in your background; this document is so disjointed and disorganized that it's virtually unintelligible.

The Marijuana Policy Project is the leading advocacy organization behind most of the state laws concerning medical marijuana, and it was one of their IL lobbyists who brought this to my attention. He wanted to know if I'd write a short article refuting the document justifying their desire to exclude CRPS/RSD, at a level understandable to the average legislator.(!) I did this, and am happy to report that the state representative who's spearheading the MM law, after reading my rebuttal, said that he would not support any MM amendment that removed CRPS/RSD from the list of covered illnesses. Here's the rebuttal I submitted.