Thursday, April 28, 2011

What About Treatment?

To considerable fanfare (press release) last week the Obama administration announced an action plan for addressing the "prescription drug abuse epidemic." Along with ONDCP, FDA, HHS, and DEA will lead the effort. Notably absent from the alphabet soup of federal agencies are CSAT and SAMHSA, or indeed any mention of treatment. The plan just lays out more of the same old supply side war on drugs that will make it harder for physicians to manage pain with narcotic analgesics in the patients who really need it, and likely restrict supply which will lead to higher black market prices, more crime, and more cartels. And more job security for DEA agents.

You might think professional organizations like APA and ASAM would raise the issue of treatment, but no, that does not seem politically correct from their point of view. In a press release treatment barely achieves afterthought status. When I asked ASAM's government relations representative, Alexis Horan, she responded with this:

"ASAM has been working with the DEA since last March to have them issue a guidance to all prescribers re: what to expect from these audits, how to prepare, etc.  We’ve also suggested to the DEA that their agents be better trained on how to perform these audits, how to work with the providers and their staffs, etc.  In fact, we’ve facilitated some meeting between local DEA agents and ASAM chapters to have an open dialogue about audit experiences.  We are also working with SAMHSA and other HHS agencies to offer prescriber training and other ways of education people about these issues.  I promise you, ASAM cares! "

In other words, "comply, comply, comply."

I wrote back:

"ASAM seems to care more about compliance than the rights of members and their patients. What keeps ASAM from demanding that DEA schedule the audits to minimize disruption? What keeps ASAM from demanding and publishing an "Administrative Warrant?" How can ASAM educate if it cannot provide such a document to its members? Is it not politically correct? What repercussions does ASAM fear if it takes a stand?

"Many of my readers believe their professional associations have failed to advocate vigorously enough where they believe their rights have been violated. Is this not a legitimate role for such an organization?"

No response to date.

What are these organizations afraid of? Why are they shaking in their boots when they hold an excellent position from which to advocate not only for treatment, but also for freeing physicians to do their jobs without gratuitous interference from law enforcement disguised as auditors. While paying lip service to "caring," ASAM, with this cowardly approach, misses the opportunity to call DEA on the carpet for discouraging treatment, thus working at cross purposes with agencies charged with encouraging treatment.

The federal government must deal with its ambivalence toward treatment if it really wants to solve the prescription drug problem, and professional associations like ASAM must keep up the pressure rather than rubber stamping failed policies.

1 comment:

  1. Sixteen years ago I attended the first Harm Reduction Conference in Oakland. The keynote speaker was Ethan Nadelmann of the Drug Policy Alliance and his message is echoed in this article. Not much has changed since then as far as American drug policy is concerned. Our government's ludicrous "war on drugs" has taken way too many casualties and in the end has cost taxpayers way too much money. Unfortunately I don't see any end in sight. When I see democratic administrations like Obama's pass the buck, I shake my head in disappointment. What is it going to take to correct this disturbingly unbalanced distribution of power? Education? Hardly—we are all aware and know better, yet the almighty dollar seems to have the last laugh. And it's not a laughing matter.