Something happened yesterday that made me want to discuss a number of issues here, but I’m not sure if I can get them all into one post. I’ll try, anyway.
A few days ago at SkepchickCon (which was amazing and which I will try to post about later), I was having drinks with Greg Laden, Pamela Gay, and a few other folks. I made a comment expressing surprise that the FDA is considering a ban on Vicodin and Percocet, drugs that I’ve always considered amazingly helpful. I don’t have chronic pain issues, but as many of you know I do play physically demanding sports and also get hit by cars a lot. I also have serious back problems that I can usually keep under control with physical therapy but often require heavy-duty pain meds. I was a little horrified that the magical drugs might go away.
Greg and Pamela explained that the problem was the combination of drugs contained in those pillsâ€”an opioid, which can be addictive, and acetaminophen, which can destroy the liver. The idea (as I understand it) is that if those are separated, people who become addicted to the op can at least take less of the acetaminophen and thus spare their livers. Also, people with pain may be able to continue taking the opioid but with lesser doses of acetaminophen because separating the two will make it possible for patients to determine if they are able to achieve adequate pain control without the full dose of acetaminophen contained in each combination pill.
That struck me as rather logical and even kind, since it’s not often I hear our government attempt to actually help people with drug addictions, other than stupidly insisting they stop taking drugs. However, I was curious to hear the opposing viewpoint, which is why I was happy to see just such a viewpoint pop up in my feed reader yesterday, courtesy of “amandaw” at Feministe, a feminist blog I read quite a bit.
Unfortunately, the post didn’t really clarify anything for me. She wrote that after the ban, chronic pain patients would have “to jump through an increasing number of hoops to obtain effective treatment,” but then failed to explain what that would entail. She made a case for why opioids are necessary for some patients, which isn’t an issue here since opioids were not being banned. She then suggests that if doctors are willing to advise patients to take Tylenol with their opioid, then they should be willing to advise them not to abuse a Tylenol/opioid combination. That seems to oversimplify the difficulty of addiction, but even if true, it doesn’t explain why this would significantly impact the lives of patients currently taking the combo drugs.
She also talks a good deal about how her life would be awful without Vicodin, and how difficult it is for her to get her needed dosage. This may be true, but it still didn’t explain for me what would change if the Tylenol were taken separately.
After reading the post several times, I clicked through to read the comments in the hopes that someone would answer the question. Happily, someone did. In comment #17, W. Kiernan explains that the combination drug is classified as Schedule III, while the opioid alone is Schedule II. This means that it’s easier for a patient to get the combination drug, which means they will face additional hurdles unless the opioid are reclassified.
Reading that allowed me to make up my mind on where I stand: before these drugs are banned, the government must reclassify those opioids and ensure that patients will still have access to the pain meds they need. Also, accessibility to the full spectrum of evidence-based pain management services should be enhanced. As amandaw mentioned in her post, the use of pain meds is only one part of management.
The other comments on the thread, though, really surprised me. “Malathion” takes issue with another commenter’s assertion that “People who take these medications KNOW that they can cause liver damage.” Malathion says:
The problem is â€“ this isnâ€™t really true. According to the New York Times, â€œeven recommended doses can cause liver damage in some people. And more than 400 people die and 42,000 are hospitalized every year in the United States from overdoses.â€ Iâ€™ve been prescribed Vicodin before, and I had no idea that a recommended dose could hurt me.
I agree with you that patientsâ€™ rights suffer when the government regulates with a heavy hand. But the medical profession has proven unable to properly manage drug interactions â€” over 20,000 deaths were caused by drug interactions in 2004. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022301780.html
I also agree that educated medical consumers like you (people with access to the internet and other sources of research and the ability to effectively advocate for themselves with doctors) can and should be able to make these decisions for themselves, in an ideal world. But the government is supposed to protect everyone, not just those people smart enough/resourceful enough to figure out their prescriptions for themselves.
In making these comments, I am in no way saying that I donâ€™t think people have a right to narcotic pain relief. That seems to be the crux of the problem here â€” itâ€™s harder to get plain narcotics prescribed than it should be.
To which amandaw responded:
See folks, we have to â€œprotectâ€ those stupid, clueless, completely-removed-of-agency people who might abuse things. Weâ€™re the smart people, but some folks out there arenâ€™t like us! They just donâ€™t know how to manage their own lives, so we have to do it for them, yanno? Sigh, the abled manâ€™s burden.
I won’t reprint the entire thread here, but I wanted to give a taste of the way that facts and an opposing viewpoint, which is expressed incredibly politely, are met with ridicule and strawmen. I made the mistake of stepping in, writing:
Amandaw: Mark and others have offered very well-reasoned and factual input to this discussion, clarifying important information about why these drugs may be banned and what that means for those who require them for pain management. Markâ€™s post had no attitude and not once did he imply anything about â€œGodâ€™s Gift To Us.â€ He didnâ€™t even write that anything was â€œjust that easy,â€ despite your use of quotes.
I read Feministe often and agree with the bulk of whatâ€™s here, but your OP and follow-up comments have surprised me. Instead of fostering a discussion about the topic, youâ€™ve responded to reasonable facts with emotional appeals, insults, and strawmen. I understand that the topic is of extreme importance to you, but you might make a more persuasive argument if you addressed the points made and realized that no one is attacking you.
In response, I was told I was privileged, patronizing, and not a feminist. The moderator said I was out of line. I was told that people with disabilities have a right to be angry, that I am ignoring them, and that I obviously don’t want to understand their viewpoints. My statement is completely twisted to mean things completely removed from the topic, such as that women have to “play nice.”
Reading the responses left me seriously depressed. On Bug Girl’s advice, I turned to our good friend Lucy, a pain-management specialist, skeptic, and all-around amazing woman, to help me better understand the many issues surrounding this topic. Her response was so illuminating that I’m going to post it hereâ€”she says the comments on that blog are understandable, considering:
“They cannot respond to the facts and opposing viewpoints in a rational way because ironically, they have adopted their own position of privilege – the PWD. Somehow, being a PWD means you have exclusive access to truth and cannot be questioned or doubted. It means that the usual standards of scientific evidence applied in medicine no longer count. So, anecdote (lived experience) trumps the insight and information of professionals. ONLY PWD can understand disabilities and can make rational decisions about their management. The FDA, doctors etc. are not to be trusted.
“Some of this does indeed come from a long history of inadequate care for people with pain. As recently as three decades ago, even people dying from cancer were denied opioids in the last few weeks of life for fear they would become addicts. And today, while opioids are more readily available to people with chronic non-cancer pain, there still exists a stigma against these people.
“However, there is a need for balance. Access has to be balanced with safety. Availability of safer formulations of drugs (the schedule change you mention), development of newer safer mechanism targeted drugs without addictive potential, and increased health related literacy due to warning on all products containing acetaminophen are potential outcomes of this change that we can and will work towards.”
I’m interested to hear what you all think about any of the topics I’ve touched on in this ridiculously long and overly serious post. Feel free to choose from the following:
1. The proposed ban: good idea or bad idea or something else?
2. Are regulations like this imposed to protect us or control us?
3. Is there a point where just asking questions or offering opposing facts becomes in and of itself offensive? Does this compare to the way many of us feel about Holocaust deniers or 9/11 conspiracy theorists?
Obviously I’m not going to moderate this discussion quite as severely as Feministe considers the norm, but I will ask you all to keep your comments civil. This incident has reinforced one of the things I love about the Skepchick community, which is our ability to discuss and debate topics while remaining relatively civil and occasionally even changing our minds.