Apparently, the U.S. Department of Justice thinks the answer to the above question is “yes.” The Justice Department’s Drug Enforcement Administration sets annual quotas for manufacturing and distributing all prescription opioids—oral and parenteral—for all 330 million Americans.
The agency presumes to know just how much pain medication, and what type and dose, each and every inhabitant of the country will require each year. It doesn’t determine the quotas without help. It acts after consulting the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services—federal agencies that also presume to divine the future pain management needs of the population. Each of the past five years the DEA has ratcheted down the quotas, seeking to prevent diversion of prescription opioids into the black market for non‐medical users. The DEA announced this week a proposal to ratchet down further, for the sixth consecutive year.
In late 2019, when it proposed its fourth consecutive cutback, the DEA claimed (Federal Register page 48172):
As a result of considering the extent of diversion, DEA notes that the quantity of FDA‐approved drug products that correlate to controlled substances in 2018 represents less than one percent of the total quantity of controlled substances distributed to retail purchasers.(emphasis added)
Already by 2018, a negligible amount of the drugs distributed and sold through pharmacies were getting diverted to the black market.
Opioids were implicated in over 49,000 overdose deaths in 2019, nearly three quarters of which involved illicit fentanyl. Yet the agency further reduced opioid production quotas for 2020. Of the 93,000 overdose deaths that occurred in 2020, roughly 70,000 were opioid‐related, 83 percent of which involved illicit fentanyl.
Production quotas for oxycodone and hydrocodone have dropped by 69 percent and 63 percent respectively since 2013. Now the DEA seems to think reducing the supply of prescription oxycodone another 5.4 percent, hydrocodone another 3.9 percent, morphine another 19 percent, and prescription fentanyl another 5.4 percent will stem the tide of overdose deaths that are almost exclusively from drugs made and obtained on the black market. And the DEA presumes to know that these quotas, the smallest in nearly two decades, are sufficient to meet the medical needs of a population that has grown by more than 50 million over that time.
Even before this latest proposal, pain patients became the real victims of this misguided policy, with documented increases in mental anguish and suicide from untreated or under‐treated pain. Suicides among veterans are skyrocketing as opioid treatments have been curtailed in the VHA system.
If your doctor continues to double down on a therapeutic regimen that is not working as intended while causing unintended harm, you should fire the doctor and get another one. Fortunately, doctors take an oath to “first do no harm,” and are unlikely to continue administering the wrong treatment in the face of such obvious harmful side effects.
Alas, the police don’t take such an oath. And that is just one reason why law enforcement should not be treating a medical problem.
# Reprinted with permission. The original blog post can be found here.
Jeffrey Singer
Jeffrey A. Singer is a senior fellow at the Reason Foundation, where he focuses on health care policy and drug policy. He is President Emeritus and founder of Valley Surgical Clinics, Ltd., Arizona's oldest and largest private group surgical practice. From 2017 to 2026, he served as a senior fellow in the Cato Institute's Department of Health Policy Studies and as a Visiting Fellow at the Goldwater Institute. Singer is a member of the Board of Scientific Advisors of the American Council on Science and Health and serves on the expert panel for Doctors for Drug Policy Reform. From 1994 to 2016, he was a regular contributor to Arizona Medicine, the journal of the Arizona Medical Association. He served on the Advisory Board Council of the Center for Political Thought and Leadership at Arizona State University from 2014 to 2018. His writings have appeared in peer-reviewed medical and scientific journals, as well as in publications such as the Wall Street Journal, Washington Post, USA Today, The Hill, and National Review. He has been a guest on national and local television and radio. Singer received his BA from Brooklyn College (City University of New York) and his MD from New York Medical College. He is a Fellow of the American College of Surgeons.
