Opinion piece author Sam Quinones: Doctors told me they misprescribed the addictive opioids – Schedule II Controlled Substances – knowing it was medically not indicated

by Clark Miller

Published December 1, 2021

The Times and Quinones, author of the remarkably revealing account of the iatrogenic opioid crisis, “Dreamland”, identify in the guest opinion piece two culpable parties responsible for generation of the increasingly lethal opioid crisis: 1) the Sackler family, owners of a pharmaceutical company that manufactured the opioid Oxycontin and 2) “us”, American healthcare consumers who asked their doctors to prescribe the addictive, Schedule II narcotics.

Not responsible? Those doctors explaining things to Quinone, doctors whose signatures were required for any American, alive or now dead by overdose, to have obtained the opioids. Without the signatures of American doctors, not a single opioid pill would have been provided to Americans for the conditions, including almost all chronic pain, known to not medically indicate use of the opioids. The doctors explained to Quinones, apparently in ways that made sense to the author and to the Times, that their patients’ desire and requests for mood-altering, addictive, Schedule II Controlled Substances when medically inappropriate is what caused the runaway misprescription of opioids and a lethal opioid crisis, with a new record for overdose deaths last year. Not the failure of clinical and ethical judgement, and cowardice, that led to the prescriptions being written. To be fair – also caused by the behaviors of Sackler family pill salesmen, who bought dinners for doctors and explained pharmacological research outcomes to them, also providing cash to doctors for speaking junkets to share the pill salesmen’s research findings with other doctors.

Doctors are literally forced, it seems, to prescribe medications, even if addictive and not appropriate medically for the condition, when patients request the medications.

Of course they are not, and it is barely conceivable that the practices could be seen as anything other than gross abdication of the obligation of any health care provider to practice in ways that avoids harm to patients.

The indications against prescription of the opioids were longstanding and easily available, would have been known to any medical professional who was able to benefit from a credible medical education or in any case from a rudimentary search of medical or research databases, or from use of Google.  Contraindications compelled to be used by any competent medical professional asked by patients to misprescribe the opioids – used to formulate clinical and ethical judgement to say “no”, unless inhibited by diminished capacity, cowardice, or both.

Media figures frightened and confused by the dilemma of telling obvious truths as against gaining rewards in the warm bath of groupthink for fingering the easy, safe scapegoats are falling over themselves to blame the Sackler family for Americans being prescribed unneeded, addictive, and dangerous opioids by – by the only source who could write the prescriptions, American doctors.

image of John Oliver on TV

From a recent post

The Sacklers weren’t the gatekeepers. No matter how nice the meals and generous the bribes, any competent medical professional using clinical and ethical judgement could have declined to prescribe, based on the evidence that was available to anyone interested in verifying Purdue’s claims, evidence they would almost have to have been exposed to in medical school.

. . .

Nor was the FDA the gatekeeper, the supplier who could have said “No” to protect Americans. The FDA could have authoritatively asserted that opioids are no more a risk than baby aspirin, or vitamin C, and it would have remained the ethical and clinical mandate of every medical prescriber to use their training and the longstanding evidence available to make the medically sound choice.

Some did, as described by Chris McGreal in American Overdose

As McGreal describes it, the clinical environment in medical practice settings became coercive and toxic – a collusion of patients trained by decades of programming to seek a pill for every distress including opioids, supported by the medical/hospital/insurance industrial complex to report doctors who would resist providing opioids inappropriately and threaten them with complaints and action by professional and licensing boards.

McGreal talked to Dr. Charles Lucas, a surgeon in Detroit who resisted growing pressure to overprescribe opioids, ended up being subject to a complaint and summoned before a hospital ethics committee for failure to provide adequate pain treatment.

(from American Overdose pp 88 – 89)

The case was dropped, but it was not an isolated incident. Luca has worked closely with another surgeon, Anna Ledgerwood, since 1972. She too was hauled before the ethics committee on more than one occasion on the same charge. One of the investigations, for alleged inadequate pain management after a hernia operation, went all the way up to the state medical board. It cleared Ledgerwood, but Lucas said more junior surgeons buckled to the pressure to administer opioids just to stay out of trouble. “If they will give me a hard time, then they will surely give a young resident a harder time,” he said. “I tend to be a fighter. That’s my nature. But somebody who just wants to take care of patients, they want to be a professional physician, they don’t want to put up with all this crap; they’re intimidated. They’re also frustrated by it. The medical community knows that too many pain medicines are being written. Doctors talk about it among themselves. They’re not in a position to challenge the system. But they know.”

Lucas regarded the new pain orthodoxy as a growing tyranny, and he thought it was killing patients.

Of course they knew. Or should have, or should not be practicing medicine.

But the forces driving runaway, medically inappropriate dispensing of opioids were not knowledge, competence, integrity or professional courage. There were other forces at play.

The extent to which we tolerate and enable the pretense of Big Pharma causing the neglectful over prescription of controlled substances to patients is absurd and pathological. It is terminal group think, literally, because the fearful failure to state and face what is obvious empowers continuing over prescription and predictable diversion, abuse and dependence.

New distracting scapegoats

New scapegoats, from America’s Medical/Media collusion – the pharmacy chains “flooding communities with pills” by filling the prescriptions for medically inappropriate opioids written – always written, exclusively written – by the only gatekeepers between those opioids and vulnerable Americans, by licensed medical professionals. 

Now everything’s a little upside down
As a matter of fact the wheels have stopped
What’s good is bad, what’s bad is good
You’ll find out when you reach the top
You’re on the bottom

Bob Dylan, “Idiot Wind”

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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