Wednesday, November 07, 2012

Criminalizing prescription drug use, distribution: The next frontier for 21st century drug warriors

Should prescription drug abuse be treated primarily as a medical or a criminal justice matter? At the Texas Senate Criminal Justice Committee last week, the answer to that question seemed nearly a faint accompli, with the focus more on tactics and best practices for maximizing prosecutions of doctors and potentially patients. See the Texas Tribune's coverage.

Americans consume 80% of the world's opiates, including 99% of the world's hydrocodone, Dr. Emilie Becker of the Texas Department of State Health Services told the Texas Senate Criminal Justice Committee last week. (Here's the agenda and here's the link to the online video.) In 1990, said Becker, the Center for Disease Control estimated there were  575,000 new opiod users nationally; by 2010 that number had mushroomed to 4.5 million, with the number of drug-related deaths rising with use. She presented this striking chart to the committee, demonstrating that last year, for the first time, drug overdoses eclipsed deaths from firearms and traffic accidents:

Drug Overdoses vs. Firearm, Vehicle Deaths

Via the Houston Chronicle.
Becker said the rise in prescription drug use increased in lockstep with number of people who die from them, but the demographic of people dying of overdoses is changing: It's more likely white, male and middle aged. She cited Austin in particular for a 41% increase in overdose deaths, which she mostly attributed to prescription drugs as opposed to heroin or other illegal drugs. Becker ominously called the "pen" a "deadly instrument in the doctor's office."

One in five Texas teenagers have experimented recreationally with prescription drugs, said Becker. By far the biggest proportion of opiod use among teens was attributed to kids drinking codeine cough syrup. The volume of prescription drugs presently on the market is vast. Sitting unused in US medicine cabinets, she said, is "enough hydrocodone to medicate every American adult 5 mg every 4 hours for 1 month "

Becker's primary suggestions involved better coordination between state regulators and law enforcement, and she agreed with other speakers that the Legislature had so recently passed new enhancements on these topics that one couldn't yet judge the impact of changing the law or what additional changes might be beneficial. But she emphasized that she wanted to target not just doctors at "pill mills" but also physicians who prescribed the pills (presumably in good faith) as part of their regular practice. That seems to step pretty quickly into dicey territory, especially for Republicans who spent the last two years bashing government interfering with the doctor-patient relationship or dictating medical care to physicians.

DPS Col. Steve McCraw continued with the tough talk, declaring, "A pusher is a pusher, a drug trafficker is a drug trafficker whether they've got a lab coat or what." However, he agreed the new laws haven't yet had tie to be fully evaluated and recommended staying the course, though at Sen. Huffman's insistence he said that if the Legislature chose to prioritize this task, it could pony up for more investigators at the agency to target doctors.

Judge Ryan Patrick, son of committee member Sen. Dan Patrick, was appointed by Gov. Rick Perry as a Houston-area district judge, but before that he was prosecuting prescription drug cases. He praised DPS for retraining narcotics investigators to monitor the state's prescription tracking program for doctor shoppers. Thanks to that shift in resources, the Harris DA saw a doubling of cases filed, all with "incredibly high" clearance rates. Most of them focused on people who go to 30-40 doctors and/or pharmacies per month, he said. "The evidence on these cases was terrific."
Multi-agency task forces went after pill mill clinics, said Patrick, but the clinics are getting smart. Some require blood draws, he said, because they know undercover police officers can't get stuck with a needle. Frequently, they're charging higher entrance fees. He said a special exception for nurse practitioners operating clinics created particular headaches. 

Prosecuting pharmacists remains difficult, he said. It requires the DA's office dealing with the administrative boards, which they'd never done before, and administrative regulators to cooperate with law enforcement more than they're used to. It's easier in some instances to prosecute patients. Under the recently enhanced statute, he said, a patient commits a felony if they go to a new doctor for a prescription and don't notify their old one.

According to the state pharmacy board, over one million dosage units were reported pilfered in 2010, declining nearly 50% in 2011. A Houston PD rep testified that recent changes in the law have been effective and suggested no changes to penalty structures, though he recommended more data gathering. Before regulation and recent penalty enhancements, he said, pain clinics would pop up around Houston "like mushrooms after a Texas rainstorm." TCJC's Travis Leet said that already 30% of incoming prison inmates are incarcerated for drugs, 75% of those for low-level possession. He encouraged alternatives to the criminal justice system, particularly for users, noting that returning veterans numbered disproportionately among those addicted to pain killers and other prescription drugs. (See his written testimony.)

Another doctor urged the committee not to interfere with the doctor-patient relationship and that there were still many people out there with "untreated pain." Sen. Huffman insisted that wasn't the intent of the committee, they just wanted to keep such drugs "out of the hands of teenagers, basically" she said. (One notices that doesn't quite get to the white, male, middle aged demographic described by the DSHS as the main prescription drug abusers.)

Finally, Jeannette Moll from the Texas Public Policy Foundation said that this is a different type of crime because most purchasers didn't purchase the drugs illicitly. She called for a statutory presumption that offenders convicted of possession be sentenced to treatment instead of prison. The presumption would not apply to trafficking crimes nor where the judge thinks the defendant poses a danger to society, she suggested. She also advocated a "Good Samaritan" exception be crafted to prescription drug statutes to encourage people to call 911 in response to an overdose.


Prison Doc said...

Oh boy! A whole other cohort of people that we can incarcerate!

Prescription drug abuse is a huge problem, maybe worse than illegal drugs in my opinion because it carries the aura of being "legal".

As with other drug abuse, Law Enforcement is NOT the solution, but it is probably the one that will be forced upon us.

Anonymous said...

"We want to go after the teenagers, basically."

Teenagers can't suffer pain?

Anonymous said...

Does this mean that prescription drug abusers like former Chief Justice Rehnquist (who got strung out on prescription pain killers for a bad back) are going to end up in prison.
Oh, goody. Just what we need.

Anonymous said...

The doctors I work with use that database routinely. They also routinely give a lot of pain meds.

rodsmith said...

Sounds like they should be targeting the doctors' you know the people passing out the perscriptions.

Unknown said...

Don't forget you don't have to abuse pills to end up incarcerated. My son is in TJJD because of an anti depressent. Once he was removed from the med he returned to his normal self. He was not abusing the pill as I keep our Meds locked up. If you watch the commercials for some of these SSRI Meds you will hear them mention changes in mood or behavior and thoughts of suicide as side effects. It happens more often than people think.

Bob said...

No, don't incarcerate far more effective to put them on extensive and intensive probation, send them to treatment at the COUNTY'S favorite treatment boutique and charge them excessive treatment and probation fees. It is also important they pay their debt to society therefore the courts should fine them for the maximum fine allowed under state law, regardless of their financial status. Pop a criminal label on them, and slap an ankle monitor on them which they should also have to pay for.

If for some reason the perp is financially devastated and can no longer pay out the nose, then send them to prison.

There should also be a registry to publicly humiliate them and their families. Future employers should beware. Neighbors should be warned.

Call it Texas Justice.

Anonymous said...

And lastly, let's create a Drug Offender Registry, cause we all know there's no cure for addiction...

Anonymous said...

Oh, yes, create a public registry so the offender can never have a decent job, rent a house, and his wife and children can live a life of humiliation, harassment and fear. This, of course, after legislators have gotten some good publicity making useless laws and after giving lots of people a good-paying job "supervising" him, keeping him chained with a GPS monitor that breaks down regularly, and really doesn't prevent anyone from doing anything. More "smart" American Law Enforcement.

Anonymous said...

Would Rush Limbaugh would support this bill?

Would Jeb Bush's daughter?

I think a whole mess of Republicans might find themselves caught up in this drag net.

The DAs need to tread carefully.

sunray's wench said...

And yet Washington State and one other that I can't remember just now have just voted to allow medical marijuana use.

Anonymous said...

They have to find a new enemy to present to the public and villainize... They are making it so hard and expensive to obtain proper pain management for everyone. This is horrible because some of us have legitimate uses for the pain medication. The ever-growing underground market is only mushrooming so much because the demand remains and the DEA is closing down the clinics. Not all of them are crooked. Very frustrating!

Anonymous said...

Now legislators know more than doctors! Ridiculous waste of money just to build up a larger and larger law enforcement "army" in this state. Very scary. Stay out of my house, my body and my personal self-liberty!

Anonymous said...

Tiffany Tillema said...
"My son is in TJJD because of an anti depressent."

I would love to hear how an anti depressant caused your son to commit a felony. Depression is not a sympton of crime.

Anonymous said...

Big pharma donates a shit ton to rick. Rick has a cake job collecting retirement, regular pay and free mansion for last 6 years. He won't let some "doctor" employed by dshs scare the legislator into doing something he doesn't want. He doesn't give a shit about drug addicts, he cares about his bank account and needs big pharma to donate to his next re-election campaign run to keep the cushy "job" he does..

David said...

I love that this issue is getting the attention is deserves. At LockMed ( we've been pushing for awareness, and I'm excited to see the passion behind the comments. If anyone wants to help us with our outreach mission and partnership, let me know!

Unknown said...

He was not depressed. He was put on them by an idiot doctor. Have youever listened to the side effects on the commercials for antidepressents? The changes in mood and behavior are extreme and can be deadly. They include suicidal thoughts and homecidal ideation. Fortunatly my son did not go that far. I encourage you to look at the website. you would be suprised at how many felonies are caused by these medications. My son returned to his normal self after he was removed from his medication.

Anonymous said...

The law enforcement approach to the War on Drugs assumes America's drug problem is a supply issue. The issue is actually a demand problem and the solution is to treat addiction to reduce the demand.

Add treatment beds to reduce waiting lists and increase maintenance programs. Believe it or not, there are many addicts out there that do not want to be addicts and would get help if it was more accessible. Treatment alternatives are much less expensive than jails and prisons.

You can take measures to reduce the number of prescription pills on the street and you will see an uptick in street drugs. If there are no hydrocodones available, many addicts will switch to heroin. See how that works?

Our current War on Drugs is no more than herding cats. It is a HEALTH issue and should be TREATED as such.

Anonymous said...

Tiffany there is no evidence that anti-depressants "cause" suicidal or homicidal ideation. Such research is correlational in nature and not cause and effect.. One theory, highly held, is that as the energy levels of someone who is depressed are restored the ability to follow through with suicidal or homicidal plans Increases. On rare occasions an anti-depressant can put one who has a pre- disposition to a bipolar d/o into a manic state. Was you son being treated for anxiety?

The problem with pain is it is subjective and any respectable pain management specialists is going to look not just medication but physical rehab, stimulators, and other alternatives.

Going after doctors, as a rule, will not solve this problem. Physicians (general practice) need better education into the types of pain and treatment methods. Also, there should be better communication and tracking of what "controlled substances" one is taking to reduce "prescription shopping."

Incarcerating abusers is and has been horrible solution.

The war on drugs has been an underwhelming success.

Anonymous said...

This legislative session the people of Texas should demand that every Senator and every State Representative be drug tested. The testing should continue throughout the legislative session and testing should be done on a random basis. Include alcohol as a drug. Texans should be assured the legislators are not mentally impaired. Lets WEED out all the users.

In fact, every elected official in the state of Texas should be drug tested on a random basis.

Start holding these individuals to the same standard that the employees of Taco Bell and Walmart are held to.

Arachne646 said...

I can't improve on what others have said; addiction is a disease, not a criminal justice issue--more treatment access is what's needed. When so many states have medical marijuana laws, why doesn't the Federal Government just change the classification of the drug, so that patients could be using it instead of these deadly narcotics for pain control--narcotics as the only or almost only strategy to manage chronic pain are inappropriate and dangerous, as statistics show.

Anonymous said...

Could we even think of locking up 4.5 million people more. Heck thats not a standing army for most countries, thats an invasion force. Time to treat medical problems like what they are and leave law enforcement to go after crimes. 18 states and the Diostrict of Columbia have medical marijuna and 2 have legalized marijuana. Doesn't that send some kind of Message.

Anonymous said...

Where have you been? Under a rock? Even GSK has admitted that SSRIs can cause suicide and violence. Thier own research shows that normal healthy individuals with no mental history became suicidal. The health care system is also beginning to take notice as well and have discontiued the use of some anti-depressents. They only ones that still hang on to the idea that SSRI's are safe are the misinformed or are working for big pharma.