Tag Archives: opioids

The FDA, Opioids and Altruism

An opioid pill (Opana ER) that successfully relieves pain is being removed from the market by the FDA—not because of any claims of unsafety or inefficacy, but because people have found a way to pulverize the drug and inject it to get “high.” Since such people risk contracting HIV or hepatitis C through the sharing of needles, no one—the FDA declares—should be allowed to take the medication: “We will continue to take regulatory steps when we see situations where an opioid product’s risks outweigh its benefits, not only for its intended patient population but also in regard to its potential for misuse and abuse.”

Obviously, this action is another demonstration that the purpose of the government’s regulatory apparatus is not to keep people from being defrauded, but to prevent them from exercising their own judgment about what is good for them.

More broadly, though, this is a demonstration of the power of the altruist creed. When the desperate sufferer of pain is to be sacrificed to the mindless drug addict—when a productive pharmaceutical manufacturer is to be sacrificed in order to keep people from indulging in self-destructive behavior—when the rational are to be sacrificed for the sake of the irrational—what could possibly underlie such injustice except a code that preaches self-sacrifice as everyone’s moral duty?

As I wrote in IN DEFENSE OF SELFISHNESS:

“If the FDA were worried that people lacked accurate information about a drug, it would simply publicize its own findings and allow patients and their doctors to make an informed judgment about whether to use the medicine. But the doctrine of altruism does not permit this. After all, if people are merely provided with medical information, the demands of the needy are not being fully met. The FDA can describe what a particular drug is and is not supposed to do, it can present the consequences of misuse, it can explain the need to consult a physician—but what if people refuse to listen? What if they ignore the evidence? . . . As long as people are allowed any freedom to make their own choices, there will always be some unmet needs—i.e., the needs of those who do not wish to make rational choices. . . .

“This argument can be made, of course, not just about medications but about everything—which is precisely what the collectivist does. Any product, from mousetraps to mutual funds, can be improperly used, particularly by those who do not care to acquire the requisite knowledge. Nothing, therefore, is exempt from the tentacles of the regulatory state. To protect the ‘needy,’ the government must control everyone’s actions.”

The Shackles of Paternalism

Today, the “nanny-state” is omnipresent. Its latest pernicious intrusion pertains to pain-relief medication. Doctors are being told to restrict their prescriptions of opioids, the drugs (such as Percocet and Vicodin) used to reduce extreme pain. Why? Because the government is concerned about patients who overuse the drugs, leading to addiction and sometimes death.

The idea of a paternalistic government, deciding what is best for each of us, rests ultimately on the ethics of self-sacrifice. It rests on the altruistic premise that you have a moral duty to surrender your self-interest for the sake of others, that you must subordinate yourself to the needs of your neighbor. Thus, those who genuinely require strong pain medication must suffer, so that their neighbors not be able to use the drugs irresponsibly.

A story in today’s NY Times describes the effects of these new controls on one doctor’s patients. “ ’I have a patient with inoperable spinal stenosis who needs to keep chopping wood to heat his home,’ said Dr. [Robert] Wergin, 61, the only physician in this rural town. ‘A one-size-fits-all algorithm just doesn’t fit him. But I have to comply.’ ” Another patient, a 55-year-old woman, “had three rotated vertebrae in her lower back, migraines and a mastectomy for breast cancer this fall. . . . Her fibromyalgia was flaring up, she told Dr. Wergin. Pain was aggravating her insomnia. ‘And you have to cut my pills again?’ she asked.  Dr. Wergin nodded.  ‘It will be very difficult to get an override for your dose.’   . . . ‘It’s rough cutting back when I’m at a level that almost works,’ she said to Dr. Wergin. A rare flicker of frustration crossed his face. ‘I’m sorry,’ Dr. Wergin said.” He could do no more for her.

As I wrote in IN DEFENSE OF SELFISHNESS (p. 165): “[T]he government regulates the medicine you may use, because other people might be tempted to take it when they shouldn’t; it regulates your retirement program, because of those who might squander their savings; it regulates your educational choices, because of those who might make foolish decisions about the schools to which they send their children; and it regulates your intake of food, because of those who might be oblivious to their health requirements. You are forbidden to choose—because of those who do not wish to be burdened by the onus of choice. You must sacrifice your freedom—because of those who are indifferent to freedom. Everyone must be dragged down to the level of the worst, and be shackled to their needs. This is how the individual becomes subservient to society.”