Sunday, June 11, 2017

The Responsibility to Protect Individuals From Themselves: Where Does It End?

In the mid-1980's, concern regarding emetine toxicity caused various members of the at-large medical community to call for restrictions on the availability of the over-the-counter medication ipecac.  Ipecac had been implicated in numerous instances of myopathy (a condition of muscle weakness) and, in particular, in various myocardial issues. The issue came to the forefront with the death of singer Karen Carpenter.  Ultimately the bid for restrictions on the availability of ipecac was rejected in the interest of the common good. The right of the public to have access to ipecac as a potential life-saving remedy* for cases of accidental ingestion of harmful substances outweighed any responsibility to protect individuals suffering from bulimia, anorexia, or any other disorder that might compel the person to misuse ipecac from his or her own self-harming behaviors. 

This was the correct decision. I would not have disagreed with a decision to limit the purchase of ipecac to adults. For that matter, it would probably be in society's best interests for the purchase of most medications to be restricted to adults.  The reasons such has not happened are purely logistical. If all cold remedies, laxatives, analgesics, and other non-prescription products were required to be stored behind pharmaceutical counters and distributed only by pharmacy employees as opposed to being kept on shelves from which consumers could help themselves, the sale of non-prescription medications would become far more labor-intensive than under the present model, resulting in increased cost, which would inevitably be passed on to consumers.   We've traded  safety for convenience and lower cost in this instance, with the reasonable rationale that almost any minor who was sufficiently motivated to obtain a supply of ExLax would probably find a way to get it with or without increased restrictions.

On the other hand, one would think that designating a substance as available by prescription only, or even further restricting the availability of the substance by specifying its status as one of greater than simple prescription-only status, requiring that prescribers provide only hard copies of prescriptions, maintain copies of written prescriptions, and otherwise closely monitor its distribution would offer sufficient protection against illicit distribution. Obviously someone with sufficient motivation to gain access to a substance would find ways around the most stringent conceivable safeguards. Acknowledgement of this, however, along with common sense, would seem to dictate that  the medical and pharmaceutical industries should provide reasonable safeguards against easy access to substances that should be controlled, but concede that anyone truly desperate may circumvent those safeguards.

An especially powerful opium-derived painkiller is currently on the market. Opana (oxymorphone)is an extended-release form of possibly the most potent analgesic substance currently available in the U.S. today. Its intended use is for severe ongoing pain.  It is most commonly prescribed for such conditions as various forms of late-stage cancer. 

The Food and Drug Administration would like to force the manufacturer of Opana, Endo Pharmaceuticals, to take Opana off the market because of the risks associated with misuse and overdose.  Some individuals will gain access to the medication and use it for recreational purposes. Drug abusers have been known to crush and inhale or inject the pill to circumvent the "extended release" properties of the medication and to acquire a more powerful euphoric state or high even than the drug in its intended form will produce. This does, regrettably, sometimes lead to tolerance, greater abuse, and eventual overdose.

Such is unfortunate. It's sad to watch a person's life be ruined or lost by a need for the high produced by a drug. On the other hand, it's even sadder to see a late-stage cancer patient suffer. If a drug would relieve or make more manageable a cancer patient's suffering, it should be available to that patient. The fact that someone else might misuse the drug does not lessen the right of a late-stage cancer patient or someone suffering similar pain to the most potent analgesic possible.  

Just as, in the 1980's, the rights of potential accidental poisoning victims to access to a possible life-saving remedy of ipecac were concluded to outweigh society's need to protect those with eating disorders against their own harmful impulses,  the rights of individuals  suffering from conditions producing severe ongoing pain should take precedence over society's need to protect drug abusers from their own forms of self-injurious behaviors. Keep Opana on the market. If necessary, limit its use to hospital and hospice settings.  Such restrictions will not entirely prevent misuse of Opana, but we as a society lack the ability, and therefore have limited responsibility,  to protect self-destructive individuals from self-destructing.

* ALWAYS consult a poison-control center before administering ipecac. 

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