Controlled Substance Act of 1970
As a senior nursing student, I have witnessed theI have seen in the hospital patients that are there due to overdose, and were near death row. Little mistakes can put someone in the edge of life and death and being so close to a personal death developed an interest in this case. My friend Natalie has been a great friend since the beginning of nursing school. My dear Natalie has suffered since young of fibromyalgia, a condition that makes the bones and joints of the body ache making the pain excruciating, unbearable and debilitating . When the weather changes specially in the winter, I remember Natalie complaining all day long about her pain and pulling and popping her pain killers. Having a rigid course load at TCU’s Nursing Program, it was very difficult to keep taking medications that relieved pain, but left her with drowsiness that did not allow her to concentrate during classes. Taking the pain medication was an everyday routine, Natalie had surgery on her right knee due to a fall back in 2009. The surgery was successful, but the needs for pain killers never ceased, on the opposite, she had to take additional doses while she was in the post anesthesia care unit (PACU) the unit where all patients recover at. The fibromyalgia increased her nerve sensitivity to pain so Natalie was in higher need for pain management before she could get discharged. After long 24 hours her pain was finally under control and we were able to take her home. Before her surgery we talked about playing nurse, we had just begun nursing school so we wanted to feel like real nurses and take care of a real patient. She kindly asked me to take care of her while she felt a little better. At the time I was living in Dallas and her surgery was in Dallas as well. Natalie’s parents lived in Abilene during the summer and at the time of the surgery their home in Fort Worth was under renovation, so it was only feasible to have her in my apartment and I agreed immediately. The drive to Abilene would have meant sitting down for two hours and that was going to put her at risk for more pain.
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We arrived to my apartment and with the help of her parents she was able to get settled in my room. We were exited to be together and really put our skills in practice. After a little while she started complaining of pain, pain that would not go away even after I gave her the strongest narcotic on her medication list. She begged me for more and I told her to give the medication sometime to work, and we did. An hour later Natalie was knocked out in the sofa, sleeping comfortably. Later that day, the pain returned and it was much stronger. I gave her her routine medications, and an additional 10mg oxycontin which is a very potent pain killer. The doctor suggested this medication PRN- as needed- for severe pain. I told her I was going to run to the pharmacy and get her some hot and cold presses for her knee, as she agreed that she was going to be fine. I came back to the apartment, and I started fixing the hot presses for Natalie’s knee as I am asking her questions such as: How is your pain, are you hungry, and immediately I noticed she was drowsy, confused and unable to formulate words. I approach her and I see that her eyes are looking to the back of the room, and I suspected that she was suffering of overdosed. I count the pills on the bottle of oxycontin and I realize that there is one pill missing, I asker if she took another pill while I was gone and she nods agreeing that she indeed did. I immediately call her parent who happen to be in the area, and we quickly rush her to the ER. The doctors furiously interviewed me and asked me many times about all the medications I had given her. I pulled out the piece of paper where I had all the scribbles of the medications I had given her, along with the times given and the food she had ingested. The head doctor realized that for her weight the dose of oxycontin prescription was too high (otherwise who knows what would have happened to me) and they start an IV containing Narcan, which is a strong medication to counteract the overdose of an opioid. After a couple hours Natalie finally recovered her conscious and the doctors said that she was a pill, a drink and an hour away from dying if we had not bring her to the hospital. All due to a medication error, myself leaving the pills at her reach when she was not capable of making coherent decisions (because pain rules) and taking more than her prescribed dose, could have changed our lives forever.
The use of narcotics and opioids in The United States has been the ongoing treatment in many of the medical facilities where Health care providers see and treat chronic and acute pain. Being responsible for the loss of the mobility and much of the disabilities of many Americans that are affected by many medical conditions, the use of narcotics becomes of high necessity in the vulnerable population, the ill and the ones in search to maintain a strategy for normal standard of health. Despite all the efforts that the US laws have placed on the regulations of controlled substances, there is still an issue with substance abuse, and potential users experiencing detrimental side effects from addiction. These policies remain to me of high personal interest, because daily, we continue to see many adverse effects and sentinel results in the health of patients either in their homes or in the hospitals. The accessibility of many of these controlled substances proposes a big threat if not strictly regulated. The interest of this topic arose with these questions: How do we regulate the legal use of controlled substances, and under what basis do we determine its safety, the population that merits its use and those who do not.
In the beginnings of the 1900’s the Pure Food and Drug Act, outlined the necessity to have more controlled standards and conditions for the use and production of medications and the regulation of them. The need of having a center that established what was safe and unsafe for the population, became a concern, and this is why the 1906 Food and Drug administration enacted the 1906 Pure Food and Drug Act .The issue with the 1906 act was that many of the questions were left unanswered: Is this medication safe to administer, how much of it is necessary to provide comfort to a patient, how much of it would it be considered toxic, and what category of risk is it classified under? The Controlled Substance Act of 1970 (CSA) became the answer after much research and trial and error regarding the need to regulate the use, misuse, categories, handling and establishing rules for safe administration. The 91stUnited States Congress, under the Nixon administration, passed the CSA, Title II of the Comprehensive Drug Abuse Prevention and Controlled Act of 1970. The federalU.S. drug policy regulates the manufacture, importation, possession, use and distribution of certain substances under the CSA. The legislation created five Schedules (classifications), with varying qualifications for a substance to be included in each. Two federal agencies, the Drug Enforcement Administration and the Food and Drug Administration, determine which substances they add to or remove from the various schedules, though the statute passed by Congress created the initial listing; Congress requires classification criteria to include potential for abuse, currently accepted medical use in treatment in the United States, and international treaties.
(4) The FDA discovered the scope of the abuse problem after a 1948 Supreme Court ruling gave the agency the authority to investigate drug sales at the pharmacy level. According to an FDA report, barbiturate transactions included: A prescription refilled 61 times, with three refills after the patient died from barbiturate intoxication, a Kansas City woman obtained 40 refills for a prescription. Her doctor prescribed refills. Other refills came by mail order. The woman died from barbiturate intoxication, the staff at a Tennessee drug store could not explain what happened to more than 180,000 barbiturates sent to the store by manufacturers and wholesalers. (Blachford, Krapp). According to the FDA report, enforcement action during the 1940s and 1950s centered primarily on pharmacies. Those involved in the illegal sales of barbiturates included pharmacists as well as drug store owners and employees.
For decades, it is believed that without pain medication the cessation of pain is nearly impossible. I say that imagery, acupuncture, distraction, among other relaxation therapies are capable of helping the most severe pain a patient can experience. In discussions of the misuse of medication administration and how easy it is to obtain such controlled substances, many argue that there needs to be an even stricter rule to those that sell, and obtain this substances illegally, placing the lives of many in danger (Balko, 2014). Other patients argue about the denial of further medical care due to “displaying the drug seeking signs of an addict”. The social stigma that is given to patients when they request more than the usual dose of pain medications and why they are denied care just because they have a higher tolerance to pain killers.
One Indiana pain patient who wrote to HuffPost (American online news blog) tells a typical story. Faced with debilitating pain from spinal stenosis, she was told by local doctors she was displaying the drug seeking signs of an addict, and they refused to treat her. “I have never used an illegal substance, and seldom have a glass of wine- I’ve never had a beer in my life,” she writes. She was finally able to find a pain specialist, but in California. She makes the trip every three months for the high-dose opioid therapy she says makes her life bearable. But the cost of flying to the west coast ever few months is taking a toll on her finances. “I have asked for help finding a pain management doctor closer to Indiana,” she writes. “I have searched online. I cannot find any one willing, or qualified to take me. I am a Christian and I do not believe in taking my own life, but I pray for an answer before I have no way to survive. I am not alone. There are so many pain patients whose lives are a living hell — waiting and praying to die.” (Balko, 2014).
The issue of pain, particularly chronic pain, is endlessly complex, and fraught with years of contradictory policies, a lack of research, contradictions in the existing research, push and pull from government agencies, and — particularly over the last few years — contentious disagreement within the medical community over what’s safe and what’s effective. For people who suffer from chronic pain that can be debilitating, the resulting mixed messages can be terribly frustrating. They face difficulty finding doctors who are willing to treat them, doctors who are incentivized to be suspicious of them, and in some parts of the country, a paradoxical influx of “pill mills” run by unscrupulous doctors, where prescriptions for opioids flow freely, but without the sort of individualized care and monitoring chronic pain patients need (Balko, 2014). (IS it ok that I cite this reference 3 times?) Of course some might object that this incidents do not happen to all populations and not all consumers experience the same kind of situations, but for those that it does the frustration of not establishing a more defined law that can provide quality of care without being worried about the social stigmas (because ultimately pain is how intense the patient sais it is), and as consumers what do we suggest it be the solution? Even as the DEA, the Office of National Drug Control Policy and parts of the Centers for Disease Control have sounded alarms about overdose deaths and the need to restrict access to opioid painkillers, other organizations are simultaneously calling attention to the number of pain patients who go untreated. “But I think there are many places [in government] where chronic pain and pain patients need to be considered, and they really aren’t. There needs to be more dialog across centers and across agencies, and that isn’t happening”. (Balko, 2014)
They are saying that- part of the problem may lie in the fact that the government agency that controls the supply of opioid pain medication in the U.S., the DEA, is specifically charged with eradicating drug abuse. There’s no countervailing charge in the DEA’s mission to ensure that legitimate pain patients have access to the drugs that can give them relief. The incentive is to err on the side of control and restricted access. (Balko, 2014)
On the other hand, there is much talk about what needs to be done and little action towards it. The statistics that target the unsafe use and administration versus the benefit obtained by real chronically ill patients are falling.
“Barbiturates.” Drugs and Controlled Substances: Information for Students. Ed. Stacey L. Blachford and
Kristine Krapp. Detroit: Gale, 2010. Science in Context. Web. 1 Dec. 2014.