Wednesday, June 29, 2011


Since we have a fair amount of discussion on the questionable value of prescription drugs in the area of psychiatric drugs, we should in fairness to the industry highlight an area where there drugs work very well- very well indeed:

…Pain killers.

Ed Pilkington in Palm Beach, The Guardian (U.K.), 9 June 2011, hat tip NC.

The Kentucky number plate on Chad's pick-up truck, parked round the back of a doctor's clinic in Palm Beach, Florida, reveals that he has just driven a thousand miles, 16 hours overnight, to be here – and he's not come for the surfing.

"It's my back," he says, rubbing his lower vertebrae. "I'm a builder. I fell off the roof and hurt my back."

That's odd, as we have just watched him run out of the clinic and over to his truck without so much as a limp. He's clutching a prescription for 180 30mg doses of the painkiller oxycodone.

Chad is one of thousands of "pillbillies" who descend on Florida every year from across the south and east coasts of America. Some come in trucks bearing telltale number plates from Kentucky, Georgia, Tennessee, even far-away Ohio. Others come by the busload on the apocryphally named Oxycodone Express.

It's a lucrative trade. Chad tells us he has just paid $275 (£168) to the doctor inside the clinic, or pill mill, as it is pejoratively called. The doctor, who can see up to 100 people in a sitting, can make more than $25,000 in a day, cash in hand.

For Chad the profits are handsome too. He will spend $720 at a pharmacy on his 180 pills, giving him a total outlay of about $1,000. Back in Kentucky he can sell each pill for $30, giving them a street value of $5,400 and Chad a clear profit of more than $4,000. If he goes to 10 pill mills in Palm Beach on this one trip he could multiply that windfall tenfold. But then there's the other cost of the oxycodone trade, a cost that is less often talked about, certainly not by Chad or his accommodating doctor.

As noted by a more thorough, but less flamboyant NPR story, Florida doctors prescribe more than 10 times the number of  oxycodone pills than every other state in the country combined – yes, combined.  Florida does not has not had a functioning drug data base, to see who is prescribing what (Source: Greg Allen, The ‘Oxy Express:  Florida’s Drug Abuse Epidemic, NPR).

Which comes to why we need a data base.

Now you could argue on Libertarian grounds that we do not need a data base, let adults make adult-decisions about their own life and pay the consequences accordingly.  However, I think it is fair to say that the Libertarians, right or wrong on principals,  are not going to convince too many people.  Most people are aware of the problems that drug abuse brings not only to the individuals, but to the whole family and community.  They are also aware that the problem goes beyond adults.

Which brings us back to the original question.  Why do we need the data base.  Why must we have these infringements on our liberty.  Why are these types of measures necessary now, but was not (arguably anyway) necessary earlier in our history.

It is because we have to many people, and we are too mobile to keep individuals accountable for their actions.  If you have a psycho-killer for every million people, than there would have been 4 of them at the birth of our country, and people would have noticed the bodies piling up pretty quickly.  Today we would have 309, and it takes us years to figure out who some of them are.

In 1790 our census head count was 3,929,214.  Our 2010 census count was 308,745,538.   That is 78 times the first census.  The growth from the 2000 census alone (a little over 27 million) was almost 7 times the 1790 number.  O.k. you say that is not fair, we are a much physically larger country today than in 1790.  Fair enough, Hawaii  and Alaska both became states in 1959.  The 1960 census was 179,323,175 population.  So we are getting close to twice the size from where we were, at about the time the typical reader of this blog was born.

The U.S. has an actually neutral to declining population without immigration.  That in of itself of course is another argument.  But we need the younger people to continue the growth that our economy needs, and in particular the bulge that is our baby boom.  China has a population bulge similar to our own.

So as we grow, we lose our liberties, and our room to maneuver.  But we need the growth to keep our economy growing.  As we noted before, there is a point at which even positive growth actually collapses an economy.

So we are in a bit of a bind.

But when you hear about the next instance where we lose more of our freedom, the chances are good it is because of marginal behavior that is no longer marginal because of the size of our population.


Ron said...

True story. I was working a night shift in the ER when an 18 yo male brought himself in for back pain. He wailed and flailed so much, the entire staff had him pegged as a mellow dramatic seeker.

Our ER Physician took a sip if his coffee, folded his paper and laid it on the counter. He stood gracefully from his desk chair and walked calmly toward the patient's room. We staff members listened intently to see how the situation would be addressed.

As he entered the tiny hospital room, the patient, as if on qeue proclaimed "Doctor! I need pain medicine for my.back! Can you give me something?" The question faded into a sobbing.

Before the Doctor could respond, another 18 year old looking boy in the corner of the room blurted out "Can you give him some dilaudid? That's what they gave us at the last place we went."

Doc turned to the pt and said "Tell you give me a clean urine sample...and I 'll give you some pain meds."

The two boys exchanged glances and looked back at the Physician puzzled."That's right," the Physician continued, "You give me a drug free urine sample and I will treat your pain with pain medicine. However, if your urine sample comes back with drugs already in it...well, I am not allowed to give you more medicine. We have a deal?"

Narry a second went by before the boys scuttled out the door and left the hospital.

russell1200 said...

LOL- Well you do have to give the boys credit for being discriminating customers and only wanting the top shelf brand.

Raleigh's News and Observer posts the picture and charge of those arrested in Wake County and many of the surrounding counties. Charges related to prescription drugs are pretty common. There is usually not an arrest though unless they are outright forging prescriptions, etc.