By L. Joseph Parker, MD

Reports sent back to Washington during the Vietnam War made it clear to everyone. The U.S. was winning. There could be no debate or doubt. It was right there in the numbers. When searching for a metric to measure “success,” U.S. politicians and the military had come to rely on body count comparisons. Defining “winning” as having a higher body count. And by that measure, the U.S. was indeed winning. We were killing over seven North Vietnamese soldiers for every one of ours.

The prevailing thought in the U.S. government was that our opponent could not possibly sustain those losses. What they failed to understand was that once this metric was chosen, those responsible would redefine combatants as essentially anyone on the battlefield. To raise their numbers. The concern for civilian casualties was lessened, and bombings became less precise. Atrocities like the My Lai massacre were not as exceptional as we would like to think. Americans were, therefore, stunned during the Tet Offensive when it became clear that the will of the Vietnamese people had not been broken. Indeed, it had been honed to a fine edge. After losing over 1.4 million citizens to our 58,220, the U.S. withdrew.

The DEA is making the same mistake today. Tasked by the Attorney General with reducing the diversion of prescribed medications, they have become obsessed with those numbers only, becoming completely oblivious to the harm they are inflicting on the American people.

According to the recently released DEA-determined quotas on opioid pain medications for 2024, commonly used pain medications like morphine, oxycodone, and hydrocodone, will be cut again from their 2023 levels. This is at a time when many chronic pain sufferers already report not being able to find a pharmacy to fill their prescriptions. Since 2015, the DEA has reduced oxycodone by 68 percent and hydrocodone by 73 percent, stating as their primary goal the reduction of diversion of these medications. This is where they completely miss the mark. Like government officials during the Vietnam War, they are obsessed with the wrong metric. What they should be focused on is reducing patient deaths, and by that metric, they have clearly failed. Let’s look at what these reductions have wrought.

As can clearly be seen in this graph, the dramatic increase in patient deaths correlates perfectly with reductions in pharmaceutical pain treatment. Why might reducing the diversion of prescribed medications cause more deaths? It wouldn’t if they were truly targeting diversion. The problem is that they have chosen to target “the risk of diversion,” prosecuting doctors under the theory that, even if diversion can’t be proven to have occurred, it could have. Because the doctor ignored the risk. Even when a doctor can prove they stopped controlled medication therapy when they suspected diversion, that’s not good enough. The DEA will find patients with unflattering histories that jurors may not like. Someone who has spent time in jail, someone who “looks” like a drug dealer. In fact, the DEA allowed testimony to be presented to a grand jury stating that “some of his patients looked like junkies.” What did they mean by that? That was made clear by another physician who reviewed the same records. “He prescribed codeine cough syrup to Black men!” was handwritten in the margins. Doctors are supposed to be aware of implicit bias. Implicit bias causes more people of African descent to receive substandard pain treatment in hospitals and clinics. It also kills women who go to the ER with a heart attack, as their complaints are more often disregarded. For this reason, physicians should think twice about denying a patient effective treatment because they “look like someone who might sell their medications.” But the fact that you are trying not to discriminate doesn’t mean the DEA and its AI algorithms will do the same. In fact, the algorithm they are using has been proven to discriminate against physicians of color. Knowing exactly why would require access to the AI training documents and query results.

As doctors became too terrified to treat anyone with pain medications, and the few treated could not find their medications due to quota reductions, more and more people ended up trying to get pain relief through unofficial channels. Family and friends at first, but very quickly, the street. And here is where we find the perfect storm of false metrics and illicit fentanyl. The federal government’s failure to stop fentanyl from flooding across border checkpoints allowed true “pill mills” to create fake hydrocodone and oxycodone tablets.

These fake pills often have just a little too much fentanyl in them, and people, thinking they are taking their regular dose of medication, die. What is the solution to this problem? The real question is, why does the attorney general of the United States abrogate their responsibility to set these quotas by granting this power to nonmedical personnel? The DEA has no clue about proper medical practice and is completely ignorant of which patients truly need what medications. Physicians must, in accordance with their beliefs, do no harm. The DEA continually confuses do no harm with have no bad outcomes. Health care providers know that our treatments will sometimes kill a patient. A certain number of patients put on aspirin after a heart attack will die of a bleeding stroke. Intent is everything, as the U.S. Supreme Court tried to make clear in Ruan, but this ruling has fallen on deaf ears, with the persecution of physicians who treat pain and addiction continuing under the theory of “ignoring the risk of addiction and diversion.”

These risks are not ignored in most cases. Just decided in a manner that a medically ignorant government official does not agree with. They think that if there is a warning letter to use caution combining benzodiazepines with opiates and the doctor doesn’t stop them, the physician has ‘ignored’ the risk, when in fact, stopping benzodiazepines in patients using opiates is more likely to kill them. I draw your attention to a recent article, stopping benzodiazepines can be deadly. This study showed that, among those with opioid exposure, the mortality risk for those discontinued from their benzodiazepines was 1.6 times that of non-discontinuers. This means that as dangerous as it is to keep someone on opiates and benzodiazepines at the same time, it is more dangerous to take them off. It needs to be recognized that physicians and health care providers need the same immunity given by our society to priests and attorneys. They must be allowed to practice according to their education, training, experience, and conscience. In addition, the power to set medication quotas must be taken back from law enforcement and given to qualified medical personnel. Physicians and other prescribing health care professionals. They are the only ones trained to make those decisions. Not the DEA, whose practice of doubling down every time they fail is proof of faulty cognition pursuing false metrics.

L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice.