DEA Pursues Vast Expansion of Patient Surveillance
filtermag.org
filtermag.org
Most importantly: we need to start treating drug addiction, and long term pain, as the public health emergencies they are and we need to stop criminalising drug addicts.
> Diversion investigations involve, but are not limited to, practitioners and mid-level practitioners who write prescriptions for no legitimate medical need and/or outside the scope of legitimate medical practice, or sell prescriptions to drug dealers or abusers; pharmacists who falsify records and subsequently sell or abuse the drugs; pharmacists who fill prescriptions that they knew or should have known were illegitimate; employees who steal from inventory and falsify records to cover illicit sales; prescription forgers; and individuals who commit armed robbery of pharmacies and drug distributors
The US does massively over-prescribe opioids. There have been doctors who were careless in who they prescribed to. There have been "pill mills" https://www.theguardian.com/us-news/2019/oct/02/opioids-west...
But they don't need patient ID to track that down. They can use supplier data.
I'm also struggling to read the document. It's written in a specific, jargon heavy, way. Use of the word "subpoena" every time they mention patient data is a little bit reassuring, but it's still not great.
> CLIN 2001 Unlimited access to patient de-identified data, to be identified via subpoena, for class 2 to 5 prescription data which includes pharmacy, medical, and dental data. Fixed price per license per month
I'm still ploughing through the 60 pages to try to get my head around it.
Task 1: Provide and maintain data on a minimum of 85 percent of all prescriptions for Schedule/Class II through V prescription drugs (additional non-controlled items may be requested for possible scheduling actions) written and/or filled in the United States and trust territories:
a) Prescription data shall include, but is not limited to:
• The number of prescriptions filled,
• The number of new prescriptions filled,
• The number of refills filled, by date filled,
• The name of the controlled substance
• The days’ supply for the patient (e.g. 5 days, 15 days, et.),
• The prescribers name and DEA registration number, and specialty
• An encrypted patient identifier to whom the prescription was written
• Date prescription was dispensed
• Payment Type: cash, government payer, commercial payer
• Dosing information: quantity and days’ sup
Here's the patient information they want:
> Patients
• Number of instances of more than one Schedule II prescription for the same drug, and written within three days of each other by different prescribers
• Number of instances of more than one Schedule II prescriptions for the same drug and written within three days of each other by the same prescriber
• Number of instances of more than two patients, with the same address, receive the same drug in the same quantity from the same doctor on the same day.
• Number of early refills Opiate and Benzo combine
• Number of early Schedule II
• Distance between patient and pharmacy
• Average distance between patient and pharmacy for a combination of Opiate, Benzo and a muscle relaxer.
• Distance between patient and pharmacy for Schedule II
• Distance between patient and prescriber
• Distance between patient and prescriber for Schedule II
• Number of Opiate and Buprenorphine combinations
• Number of Paid “cash” Schedule II
• Number of Oxycodone 30 MG and 15 MG within five days overlap
• Number of times Opioid Cough Syrup exceeds 90 day supply
• Number of Oxycodone 30 MG and Hydromorphone 8 MG within five days overlap
• Average MME Per Day
• Average Total MME per pharmacy visit
• Number of Opiate and Benzo combine within 3 days
• Number of Opiate and Benzo prescriptions for the same person on the same filled day at different pharmacies.
• Number of Opiate and Benzo prescriptions filled for the same person on the same day from different prescribers
• Number of Opiate and Benzo prescriptions written on the same day to the same person by different prescribers
• Number of Opiate and Benzo filled on the same person on the same day
• Number of Opiate and Benzo filled for the same person on the same day at the same pharmacy
> f) Fully HIPAA-compliant.
> Current pharmacy and prescription data updated on a daily basis.
> Task 2: Streamline process for requesting the unmasking of pharmacy information. (PII shall be withheld or redacted unless specifically requested by subpoena.)
You are missing the page before:
>Non-specific patient demographics (gender; age group; city, state, and zip code of residence)
This doesn't seem HIPAA compliant according to the safe habor rules: https://www.hhs.gov/hipaa/for-professionals/privacy/special-...
It would also be almost impossible to use expert determination, for this is often done using statistical methods that are impossible to apply on changing datasets (such as k-anonymity).
edit: They also ask for an "encrypted patient identifier".
This is not just over-prescribing, this is intentionally creating addicts and should be criminalized asap.
But every dentist I've had - every - has asked about taking out my wisdom teeth.
And not one of them could give me a good justification. I still have them.
A legitimate reason MIGHT be you can't be a navy seal if you have your wisdom teeth because apparently something with deep diving affects them. :)
It's a fairly common sequence of events as far as I'm aware
Then he proceeded to remove my molars and let my wisdoms grow in and replace them, so maybe he was just nuts, I dunno.
Can imagine valid reason to opt for wisdom tooth instead of existing molar. For example the molar can be damaged already, or easier taken out. IANAD though (I Am Not A Dentist :-).
I am from the Netherlands where natural birth without painkillers is also still the norm. You can always opt for them and cesarean but one should know that numbing everything away and taking the kid through a newly cut hole also has its downsides (studies show). Spoken like a true man ;) Seriously, I'm not judging, just sayin'.
> This is not just over-prescribing, this is intentionally creating addicts and should be criminalized asap.
I'll devils advocate. But only barely.
So, lets say your friend didn't take them, went home, and day 2 something gets way more sore. If she tried to go back to the hospital to tell them, there is a possibility she gets the wrong doctor, gets a note on her file as 'seeking', and then is up a creek without a paddle.
This doesn't take away from the issues with overprescription and marketing. But speaking as someone who had to learn about some of this, the hospital did the shitty but correct thing
Source: because of the sheer -volume- of ADD meds I have to take and my aspergers, I got a good course from my doc on understanding how not to accidentally look like a seeker
Would they be a seeker if they took home the meds and not actually take them? The drs would then think "why more pain med, they are already on some?"
or of they didn't accept and take home the meds from the drs? So then the drs would think when they return "they are here asking for more help when they rejected the help we gave them before, are they seeking attention?"
Perhaps it means something else?
> Would they be a seeker if they took home the meds and not actually take them? The drs would then think "why more pain med, they are already on some?"
No, that's not seeker behavior. An 'extreme' example of seeker behavior would be to take the pills home, and try to come up with the best excuse possible to have 'lost' them.
> or of they didn't accept and take home the meds from the drs?
This is the scenario I'm talking about more. The problem is, if the patient comes back, depending on where the patient went, they might not get the same doctor as before (Thinking scenarios like urgent Care, ER, etc). And when you are in a lot of pain, you might not always think/act rationally. Ironically your desire to deal with immediate severe pain could in fact look from the outside as someone going through withdrawls.
It's annoying as hell, because if you make the unfortunate mistake of associating with an onverly nervous doctor and you're on a controlled substance, it can lead to a life ruining adjustment of your dosage. (Happened to me right after a job loss.)
Showing up with a 20 odd year file of history of successful treatment history on something helps, but you still have to be hyper vigilant about finding a prescriber willing to work with you without being flaky. Yoy can't even think of moving or long term visitation somewhere unless you're made of enough money to do some recon work ahead of time to find a doc at a new location, or return wherever your old one is for the interim to top up fill your prescriptions.
As a person with a valid medical justification, I'm basically already in a gilded prison created by DEA where I have to essentially mother-may-I either the insurance company or physician anytime I want or need to relocate for more than 30 days.
And God help you with tolerance built up. Then you're adding a new monthly family member unless you figure out how to nutritionally supplement for your particular body chem to get around it.
I will shed no tears over massive fefunding of DEA or restriction of their Draconian scope, but I have the feeling I'll never see it, because there is too much self-destructive potential and black market incentuve for illegal trade to ever become small enough without an organization putting pressure on it. That may be some level of Stockholm Syndrome talking though, as I'm not sure I don't just tell myself that to keep myself from wasting my time shouting into the wind.
Are doctors by default nervous about this? Can't they share your file between them? (I'm in Europe, so my experience is different, sorry I don't know these basics).
Is the fear from doctors and the draconian DEA's scope left over from the "War on Drugs"?
The fear comes from DEA as they track metrics from pharmacies, and are tge source of all prescription pads for controlled substances. If you end up looking suspicious enough to look into, you could very quickly find yourself in very hot water. You could lose access to the privilege to write controlled substance prescriptions, which means lost patients, have your license revoked, or any other unpleasant outcome.
You have to have a good relationship with your physician, because if for whatever reason the start feeling overly exposed professionally, your adverse health outcome is less severe to them than possible investigation by authorities or jeopardization of their ability to see patients.
The sad thing is, I can't even really blame them. It's 100% reasonable from their point of view, and from an outsider's, but as a patient trying to navigate your own physiology in a way that doesn't end in catastrophic consequences for yourself, those you know and love, and those depending on you to play your part in the grand scheme of things, it sure does feel like everyone is a-okay letting you take the fall for the sake of the perverse incentives created by the regulatory environment.
https://slatestarcodex.com/2019/09/16/against-against-pseudo...
Later my psychiatrist retired so I needed to find a new one. The new psychiatrist interrogated me about my use of opiates. He asked if I had taken opiates before. I answered no because I hadn't. This was his gleeful gotcha moment where he pulls up my prescription history to find the opiate prescription and accuse me of lying about drug abuse.
It was a university health system and he was pushing a new medication on me. That same day I found out the manufacturer of the drug he wanted to put me on had made a $10 million donation to the university. I guess he was going to try to get me to feel like a drug abuser and like I have no choice but to take this new medication?
Anyway, he was successful at making me feel like I was a drug abuser so I just left and stopped taking psychiatric medications altogether. I probably didn't need them. Also you can be labeled a seeker even if you fill the prescription instead of going back to get it.
I'm assuming there were significant kickbacks to oral surgeons from the opioid sales people.
Most of the time it would be generic vicodin and cost under $20 for enough to take for a few days.
It was my opinion before doing it that I would be feeling some amount of pain no matter what I did. So I just followed the other aftercare instructions first - ice it, take ibuprofen, (lightly) swish with warm salt water. The pain was reduced enough that I didn't feel the need to take the opiates.
I definitely get the impression that a lot of people sucked into pain med addiction are not the sort that have had a lot of previous experience with pain. Making it doubly irresponsible to prescribe such highly addictive medications for them.
I took ~10-15 then and would occasionally take one as needed in the intervening 7 years and still have some left.
Would this paint me as a responsible user or a monster taking prescription meds without doctor’s supervision)?
That being said, I did same with Ritalin. It helped me focus during times I needed (same reason it got prescribed though not for using it casually but regularly). Eventually I got rid of it though.
Heck, even Ibuprofen 600+ mg can only be bought with prescription. For a oral medicine / huge swelling I had to get a procedure, and this helped. I got prescribed Oxazepam because of my fear of needles. I used 1x 10 mg before the night of procedure, 2x 10 mg an hour or so before procedure. I walked like a drunk. Yep, I get why this stuff is addicting.
(Tylenol with small amounts of codeine is over the counter here, but meh).
Wow, for some conditions that sounds like not at all an outcome a psychiatrist would like to be responsible for.
The new psychiatrist was how you might expect any psychiatrist to be - fake sincerity. So yes, there was a sense of "oh no we don't want you to stop cold turkey ;) why don't you take this new medication." The recommendation to change to a new medication manufactured by a major donor to the university was a red flag that made me decide to stop altogether.
Jail the doctors. They are getting bribes from drug companies.
My provider makes me sign an expansive privacy waiver to get my prescription. I gave up the drug for awhile because of it, I had to come crawling back and sign it.
The AMA embraces this total abdication of their responsibility to protect patient privacy. A federal registry is the natural next step.
As an attorney I cannot imagine selling out my clients the way MD's do.
You might be (not at all) surprised to learn that the largest opposition to this shift is the DEA itself (It's the DEA's fault, for example, that it's so difficult for addicts to get Suboxone even when prescribed). In terms of lobbying dollars, #1 is the police and prison guards union.
I also don't think DEA agents [signed up to punish minorities]. You might be projecting your bias.
the titles suggest different dynamics , different activity focus
Drug enforcement was, from the beginning, founded in racism and anticommunism: https://qz.com/645990/nixon-advisor-we-created-the-war-on-dr...
>...Multiple family members of Ehrlichman (who died in 1999) challenge the veracity of the quote: The 1994 alleged 'quote' we saw repeated in social media for the first time today does not square with what we know of our father...We do not subscribe to the alleged racist point of view that this writer now implies 22 years following the so-called interview of John and 16 years following our father's death, when dad can no longer respond.[22]
https://en.wikipedia.org/wiki/John_Ehrlichman
This is a very explosive quote - if Baum had included it in his book in 1996 I am sure it would have garnered a huge amount of attention for the book. Instead Baum did not include it in his book, but instead would wait for many years before making the claim when Ehrlichman was no longer around to dispute the quote.
At any rate, if the quote was actually said by Ehrlichman, it isn't a very accurate description of the overall drug polices of the Nixon administration. While Nixon is remembered for "war on drugs" rhetoric, the actual substance of his policies seem to be different than what people think it was:
>...I have been fortunate over the years to discuss the distorted memory of Nixon's drug policies with almost all of his key advisors as well as with historians. Their consensus is that because he was dramatically expanding the U.S. treatment system (by 350% in just 18 months!) and cutting criminal penalties, he had to reassure his right wing that he hadn’t gone soft. So he laid on some of the toughest anti-drug rhetoric in history, including making a White House speech declaring a “war on drugs” and calling drugs “public enemy number one”. It worked so well as cover that many people remember that “tough” press event and forget that what Nixon did at it was introduce not a general or a cop or a preacher to be his drug policy chief but…a medical doctor (Jerry Jaffe, a sweet, bookish man who had longish hair and sideburns and often wore the Mickey Mouse tie his kids had given him).
https://www.samefacts.com/who-started-the-war-on-drugs/
>..."Enforcement must be coupled with a rational approach to the reclamation of the drug user himself," Nixon told Congress in 1971. "We must rehabilitate the drug user if we are to eliminate drug abuse and all the antisocial activities that flow from drug abuse."
>The numbers back this up. According to the federal government's budget numbers for anti-drug programs, the "demand" side of the war on drugs (treatment, education, and prevention) consistently got more funding during Nixon's time in office (1969 to 1974) than the "supply" side (law enforcement and interdiction).
>...It became the sole focus of legislative activity for the remainder of the session on both sides of the aisle. Literally every committee, from the Committee on Agriculture to the Committee on Merchant Marine and Fisheries were somehow getting involved. Suddenly, the Len Bias case was the driving force behind every piece of legislation. Members of Congress were setting up hearings about the drug problem and every subcommittee chairman was looking to get a piece of the action...
https://www.salon.com/2011/06/19/len_bias_cocaine_tragedy_st...
If you want to go back further, a good person to start with is Harry Anslinger who headed the Federal Bureau of Narcotics:
>...Prior to the end of alcohol prohibition, Anslinger had claimed that cannabis was not a problem, did not harm people, and "There is probably no more absurd fallacy"[15] than the idea it makes people violent. His critics argue he shifted not due to objective evidence but self-interest due to the obsolescence of the Department of Prohibition he headed when alcohol prohibition ceased - campaigning for a new Prohibition against its use.
https://en.wikipedia.org/wiki/Harry_J._Anslinger
A difference with Nixon is that he was one of the first to try to greatly expand drug treatment and also reform sentencing in at least a small way:
>...the mandatory minimum sentence in a federal prison for marijuana possession was 2-10 years until Nixon slashed it to 1 year with a judicial option to waive even that sentence. No federal mandatory drug sentence would be rolled back again for 40 years (in the Obama Administration).
https://en.wikipedia.org/wiki/War_on_drugs#20th_century
>The Nixon Administration also repealed the federal 2–10-year mandatory minimum sentences for possession of marijuana and started federal demand reduction programs and drug-treatment programs. Robert DuPont, the "Drug czar" in the Nixon Administration, stated it would be more accurate to say that Nixon ended, rather than launched, the "war on drugs". DuPont also argued that it was the proponents of drug legalization that popularized the term "war on drugs".[17][unreliable source?]
>The presidency of Ronald Reagan saw an expansion in the federal focus of preventing drug abuse and for prosecuting offenders. In the first term of the presidency Ronald Reagan signed the Comprehensive Crime Control Act of 1984, which expanded penalties towards possession of cannabis, established a federal system of mandatory minimum sentences, and established procedures for civil asset forfeiture.[50] From 1980 to 1984 the federal annual budget of the FBI's drug enforcement units went from 8 million to 95 million.
tl;dr: Nixon removed mandatory minimums for drug sentences, Reagan reinstated them.
They needed to justify prohibition era law enforcement budgets after prohibition ended, and explicitly targeting blacks was politically expedient.
All I know is that there are at least three hedge funds with the ability to acquire individualized prescription histories. I don't know if they are able to "deanonymize" guids in a large database, or if they query based on the individual.
Congress should start asking questions.
There are many companies that offer the data for sale. The example I link seems to require HIPAA authorization from the individual, but the authorization is not actually required by law. It also raises the question how the vendor is able to acquire the data without HIPAA authorization.
The data is advertised as "real time".
For what it's worth, my money is on "deanonymizing" guids. Hedge funds want to track sales in real time to have an edge in earnings forecasts.
(Or whether what they’re doing is borderline legal to begin with)
Yes it will! Because then other people can confirm your claims.
I can't read minds, but I think an equally likely formulation might be "people who signed up to enforce the law on the criminal organizations that perform most drug trafficking"?
I think most petty drug enforcement (of the kind that targets users, rather distributors) is by the states, not the federal government, and therefore much less likely to be done by the DEA.
Meanwhile, Oregon.
There is no limit to the things those who profit from the activities will do to achieve their goals, including erroding our constitutional right to privacy and pursuit of happiness.
RIP America.
1. This assumes it’s impossible to disincentivize drug usage via really harsh penalties enforced by state power. But look at China, where they have very little drug usage, due to extremely harsh penalties, and extreme social stigma. Individuals don’t get “mind expanding” or therapeutic benefits of drugs, but at least the society is not paying the cost of externalities of drug usage (see San Francisco’s Tenderloin).
2. Not all who do drugs are rational individuals with full information about what might happen if a chemical dependency is established. There are people pressured into drug usage by both legal mechanisms (Purdue Pharma) and illegal mechanisms (e.g a pimp creating a prostitute by forcing a drug addiction on that person). So the implication that there’s no bad actors, and it’s just the state enforcing draconian measures, misses very real cases of bad actors who should be stopped and punished. A legal system that pursues and removes bad actors can help society.
From what I've read over the years, there actually is notable drug use in China for instance among factory workers.[1][2][3]
Also I'm sure lots of people on HN who are more intimately familiar with the Tenderloin can opine better than I but from what I understand, drug usage in Tenderloin is more of a symptom - not the core problem. Similarly, the drugs being used openly in Tenderloin are not the ones that individuals normally tout as "mind expanding" or therapeutic.
[1] https://pubmed.ncbi.nlm.nih.gov/30359871/ [2] http://www.xinhuanet.com/english/2019-06/26/c_138175718.htm [3] https://www.csmonitor.com/World/Asia-Pacific/2015/0503/Break...
How do you know these are the reasons?
That's not the case though. China has lots of drugs, probably more than the US. Many of the powder based drugs in the US are made in China. When you go on a business trip there they flaunt all sorts of things from prostitution to drugs. As long as you're rich it's no problem.
>Not all who do drugs are rational individuals with full information about what might happen if a chemical dependency is established.
This is why in a perfect world we have to take a test to take certain drugs. It could be handled at the dmv. Once you're certified you can buy a specific quantity based on being an informed actor. It's how we handle other dangerous activities.
And yet China is where literal tons of drugs like fentanyl and its derivatives are manufactured illicitly and shipped around the world.
2. so what? do we fix their lack of information but allowing the DEA to publish (demonstrably false and misleading) propaganda under a guise of 'think of the children'? To assume that the DEA themselves aren't seceptible to bad actors is downright naive, dangerous even. All evidence points to the fact that our drug policy has failed to mitigate any of the social costs related to drugs, and in most cases, has increased social burden.
If de-identification is done right, it would be a bit of a stretch to talk about "surveillance" because that's the whole point of de-identification: remove any information from the records that allows a third-party to identify the underlying person from whom the data originated. Note especially that this includes inference attacks, i.e., not only should any occurrences of names be removed/masked but also any information that would allow an informed attacker to re-infer that information, i.e., cross-link the patient data back to a specific person.
The big elephant in the room, however, is the "If" at the beginning of the previous paragraph. As far as I see it, the problem lies not in wanting to establish some functionality that actually uses the collected information but whether appropriate privacy prerequisites have been put in place prior to that.
They ask for: Gender, Age group, Zipcode and City
HIPAA already considers that too much under their safe habour rules, and k-anonymity (expert determination) can hardly be applied if you need to provide full zipcode and have a data-set that will grow/shrink over time.
https://www.hhs.gov/hipaa/for-professionals/privacy/special-...
edit: oh, and it seems they also ask for a "encrypted patient identifier", definitely doesn't seem kosher
UID, Gender, Age group, Zipcode and City, plus of course your medication habits, is probably enough to deanonymize with a reasonable amount of confidence. Say age group is one of 8, age+gender is 5 bits of entropy. City zip is ~8. So that's 15 bits left on a good day.
Throw in any off-the-shelf targeted marketing data (usally worth 10-25 bits iirc) and you might as well use SSN as the patient ID.
> If de-identification is done right
There is the rub, indeed. As a general rule, I don't trust de-identification. People mostly seem to reason poorly about how datasets can be merged and this has repeatedly failed.
Worse, I have seen it proposed to shut people up about privacy in situations where the proposer knew full well it would fail. De-identification was merely a prop in a con.
I would suggest that, if sensitive de-identified data is to be used by government, it go through a public trial challenge round. Let's let the public give a shot at it, it would build confidence and help suppress a little conspiratorial nonsense too, something we could use right now.
The US medical profession completely rolled over and sold out their patients. I can't figure out why, unless it is part of a deal to avoid being pursued or prosecuted for their part in creating the opioid crisis.
From Q&A:
> Answer: The provider of the information would need to have approvals to provide the information to DEA and provide it without additional costs or approvals from the original data provider. We would need it to be able to be analyzed outside of the host environment so that we could take the results of the query and create our own reports and dashboards and provide it to the necessary individuals in the field who could use the data for investigative purposes.
So... this information is required to be provided to the DEA by law... but apparently some 3rd party entity is receiving it (I'll bet this is for LexisNexus) with apparently no restrictions on how its used and now the DEA is going to pay a stupid amount of money so they can do whatever shady shit they have planned.
Also note this is an RFP, so the decision to do it has already been made, this is basically the procurement of the service happening here.
Seems like a better solution to me than giving a law enforcement agency access to a patients medical records.
The lobbying of pharmaceutical companies is corosive to good medicine. I have a few doctor friends here in Czechia; even here, in a public health system, representatives of pharma companies do their utmost to cultivate a client-patron relationship with doctors, to get them to prescribe more drugs.
This year, I got off my antihypertonic medication by intermittent fasting. After 17 years no less. My cardiologist said: "OK, you do not need them anymore and you surprised me a bit, but do not expect others to follow your example. It is so normal just to take pills that people won't even try any lifestyle modification."
This is a dangerous norm.
I strongly suggest reading this post for an alternative perspective on how damaging over-politicization of doctor-patient relationships can be in either direction.
https://slatestarcodex.com/2019/09/16/against-against-pseudo...
I commend you for doing the work you needed to do to get healthy! I wish more people would take that route instead of taking pills. It is so much more rewarding!
...
Seriously. The other Orwellian agency installments are at least iffy with some potential justification for their existence, but I struggle to think of any way my life would be worse if the DEA were to just... not.
I mean, if we're going to defund the police, you can't pick a better target than the DEA. Just get rid of them. They represent everything that's wrong with moral policing.
In an ideal world, they would be defunded, the department's charter revoked by congress, and every employee investigated for criminal activity. See if they like a taste of the same bullshit they dish out to the rest of the country.
Honestly just reverse the drug bans, treat them life public health problems, and disband agencies like this. Nothing good has ever come out of giving government agencies this kind of power and this kind of mandate.
ATF wants you to hold its beer.
Seriously though, there's at least a few old farts who don't hate the DEA. The ATF has far fewer people who don't hate it.
Also a good idea because physicians are less likely to prescribe you the same as someone else who doesn't use illicit drugs. They often make no distinction between someone telling them they use LSD once a year, or someone who admits they use opiates recreationally.
In the US, it is good practice to be careful with what you say to doctors, especially about drug use because patient-doctor privacy is mostly a myth these days.
The DEA already have the ability to ask for specific customer records without a warrant through HIPAA privacy rule exceptions. And good luck convincing your therapist or doctor that fulfilling such requests is a voluntary act on their part. That highly televised doctor-patient confidentiality is pretty much a myth once you reach the federal level.
That is bad enough, but now they want to simply take everyone's data and push it through algorithms to generate leads for more action? These guys are worse than sales people.
But I'm not quite sure what we should do about drugs, if anything. It's easy to write off adults for making poor choices, but many drugs are highly addictive and addiction often starts with children.
I can't say I'd be happy about a 7-11 selling heroin or meth.
But doesn’t 7-11 already sell alcohol, and even in potentially lethal amounts?
While no one is advocating for that, but it used to be like that, in that you could go to a drug store and get opioids and what not. Coca-cola used to have cocaine in it, and so on.
In the past we were better off than today. People were not shooting up in the streets, yet heroin was readily available. The past is not the ideal path forward. We can do better than the past, and we can certainly do better than today.
A middle ground needs to be found (a global maxima) between de-regulation and over-regulation. I personally think having to take a test so you're an informed consumer is an ideal amount of regulation, but others might disagree.
Offer drug treatment and rehab options for those who want to quit. Most people absolutely do not want to be addicts because addiction makes their lives miserable. It is incredibly expensive to seek treatment for drug addiction in this country, and there is a shortage of beds and caregivers relative to the number of people currently seeking treatment in the US.
> I can't say I'd be happy about a 7-11 selling heroin or meth.
That's hyperbole, but government funded clinics that supply people with cheap and uncut drugs, and a place to do them, does a lot for harm reduction in the countries with such programs.
I don't think anyone here is saying that. What's interesting is no matter what doctors do, 11% of the global population is addicted to drugs. I don't think prescribers can influence that. Psychologists can, but most drug addicts suffer from avoidant personality disorder, which is regarded as the single most difficult psychological disorder to work with.
Defund. Defund. Defund.
mtgx 9 hours ago [dead] [–]
Just when marijuana is about to be legalized at the federal level. This can't be a coincidence. They will no longer be able to arrest people for marijuana, but now they can arrest them for dozens or hundreds of other drugs. Seems like a net "win" for the DEA.
The privacy implications are horrifying.
After hearing about Oregon's recent de-criminalization of hard drugs, a bunch of druggies were celebrating by doing cocaine in a public park. An officer walks up to them and says, "Is that a plastic straw?"
edit-to-add: but the state registries are not de-identified.
There would not be much of a black market for it if physicians and pharma were not getting people addicted.
this is a bold claim to make. it's worth having a wide range of drugs in a particular class, because they all have different side effect profiles and will affect individual patients differently. the short duration makes it ideal for use as an anesthetic, for instance. it is also safer than many of the older opioids, in the sense that the difference between an effective and lethal dose is much larger. when the short duration is not desired, this can be easily fixed with a time release mechanism.
the main danger with fentanyl is it's high potency by weight. this is not an issue in a controlled medical setting, nor with the transdermal patches that are typically used in outpatient.
> There would not be much of a black market for it if physicians and pharma were not getting people addicted.
this reflects a misunderstanding of the psychology of addicts imo. the exact opioid is usually fungible to an addict; they want whatever gets them the most high for the least money. they probably have a favorite, but you rarely hear of people who specifically seek out fentanyl. in other words, I don't think there are many people who are addicted to fentanyl specifically.
These are the kind of people who aren't smart enough or well enough to get a prescription of what they need, so they have to turn to the streets.
In the 1950s there was an antidepressant that worked on the kind of depression today we call treatment-resistant depression. You can still get it prescribed, but it's a pain in the ass, because it's opioid based. It's a long lasting 12 or 24 hour patch that normalizes the persons pain and emotional state. It doesn't get them high but it normalizes them. It's not ideal for physical pain, but for most forms of mental pain, which is why many turn to the street, it is ideal. These people should be getting prescribed with this, but they don't know about it and getting it is near impossible because of the stigma.
Every new iteration of drug is worse than the last. People were not out in the street shooting up when the drug war started, but before the drug war heroin was easy for anyone to obtain. They had better tools then. As counter intuitive as it is, the drug war created this mess.
Second, what you're basically asking for is MORE WAR ON DRUGS. Addiction is public and mental health problem, and should be approached as such. DEA is the last agency you should plead for help in times of crisis such as this opioid one. Harm reduction programs are proven as best way to tackle such problems, proven time and time again around the world.
Third, calling fentanyl "Chinese fentanyl" is reminiscent of recent declarations of "Chinese virus". It's fentanyl. It doesn't have nationality.
And yeah, I do think that not preventing its import is doing a tremendous amount of harm. If you want to call this "war on drugs", call it what you wish, but I think everyone would be better off if the arrows in that PDF were eliminated.
It doesn't say that at all, it says that most of the _import_ into the US is Chinese made fentanyl. It does not touch at all on US made fentanyl.
All they do is partially constrain the supply, increasing the price and thus profitability of smuggling the drug in.
The best way to fight "Chinese fentanyl" is with non-DEA harm reduction measures: free drug treatment, education, and creating a social safety net so addicts don't have to resort to crime to stay off the street.
Want to beat Chinese fentanyl with a single stroke of the pen? Make a program where addicts can go into a center daily to get pure government-paid-for heroin. The vast majority of societal harms from illegal drugs come from the effects of prohibition: free clean drugs would make smuggling no longer profitable, would create a centralized location for social services to communicate cessation options to addicts, and remove the "I need money for drugs" cause of the overwhelming majority of drug-related crimes.