Made to be Broken: laws you can ignore

October 15, 2007 7:19 AM

American Lawbreaking. "This series explores the black spots in American law: areas in which our laws are routinely and regularly broken and where the law enforcement response is … nothing. These are the areas where, for one reason or another, we've decided to tolerate lawbreaking and let a law—duly enacted and still on the books—lay fallow or near dead." The first two entries are prescription drug abuse and internet pornography.
posted by ND¢ (84 comments total)

People are often asking "Is this illegal?" when really that is the wrong question. Lots of shit is illegal. Speeding is illegal. The right question to ask is "Is this likely to cause me to suffer adverse consequences? Does the risk of those consequences outweigh the reward of the activity itself?" and that calculation can't be accurately made if your thought process stops at "This is illegal, so there is a large risk that I might go to jail. I will not do that."
posted by ND¢ at 7:27 AM on October 15, 2007 [4 favorites]

Internet whatography? Never heard of him.

How about the spots where laws are routinely and regularly broken but "we" have not decided to tolerate and yet still the response is nothing? Corporate America, I'm looking at you.
posted by DU at 7:30 AM on October 15, 2007 [2 favorites]

What DU said. The TV show Cops pretty much shows where our priorities are.
posted by rolypolyman at 7:41 AM on October 15, 2007

His argument on "prescription drug abuse" is idiotic. According to his logic, nicotine and cocaine are the same because they act on the brain via the same mechanism. But come on, they are not the same.

I don't exactly think the logical foundation of the drug war is sound, but using that logic it's fairly obvious to see that prescription anti-depressants are not the same as cocaine or LSD. (maybe marijuana, though)

Plus, if it's not actually illegal how is it actually law breaking? I mean just because doing X may be as enjoyable (or enjoyable in the same manner) as doing something illegal it's the same as doing something illegal.

So, by his logic, downloading free promotional and Creative Commons licensed music is just as bad as Infringing copyright, because it's just as enjoyable.

By his logic, winning a free car is just as bad as stealing one, because it's enjoyable in the same way.

Slate sucks and is full of morons.
posted by delmoi at 7:41 AM on October 15, 2007 [1 favorite]

Or the adverse, where we, the people, don't give a shit, yet people get locked up. I'm looking at you overzealous government regulators (but I'm doing it quietly so that no one at my overzealous government regulatory office notices and shit-cans me).

But really, welcome to the world of politcians as leaders. Politicians, like most of us, often couldn't really give a shit about things, yet at the same time must make a big show for the grannies back home that write the fat checks. So, we get "tough talk" on preverts on the internets, but in reality just action to make sure kids aren't getting buggered and a general wank-fest otherwise.
posted by Pollomacho at 7:42 AM on October 15, 2007 [1 favorite]

Also, his article on pornography misses the point that "obscenity" is defined by "community standards" Mainstream porn is no longer considered "obscene" by most people.
posted by delmoi at 7:44 AM on October 15, 2007

Oh, and you want to know the real difference between Republican politicians and Democrats? Democrats will say hi when they pass you in the liquor store, the sex shop or heading out of a men's room.
posted by Pollomacho at 7:45 AM on October 15, 2007 [3 favorites]

Sensible people take anything that CASA OR Califano say about drugs with a large pinch of salt.
posted by PeterMcDermott at 7:45 AM on October 15, 2007

And from a local perspective let me include the following list. Of course exceptions for ALL of these if the victim is wealthy, politically connected, or the government.

Home burglaries
Car thefts
Illegal parking in neighborhoods
Drug deals in neighborhoods
County codes re: trash, rodents, etc (aren't these laws? I could be wrong on the definition of "laws")
Zoning laws re: new development

Enforcement of zoning and code enforcement usually require lawsuits by community members, who generally can't afford such things.

Can you tell I'm the president of a civic association?
posted by Red58 at 7:50 AM on October 15, 2007 [1 favorite]

The right question to ask is "Is this likely to cause me to suffer adverse consequences? Does the risk of those consequences outweigh the reward of the activity itself?"

That's another black spot in American law, where the lawbreakers are mega-monied corporations and the penalties are diddle-shit fines that the corporations can shrug off as just another cost of doing business.
posted by jason's_planet at 7:52 AM on October 15, 2007

His argument on "prescription drug abuse" is idiotic.

Not only is it idiotic, it's actually dangerous idiocy. In a country where people with severe and intractable pain struggle to get adequate pain medication, and where doctors are routinely being sentenced to prison for providing legitimate medical treatment to pain patients, anything that attempts to elide the differences between recreational drug use and legitimate medical treatment is either being dishonest, or a disingenuous running dog for the drug warriors at the DEA.

May he never have to watch as his loved ones die in the agonies of terminal illness as pleads for something more than an asprin to relieve their suffering.
posted by PeterMcDermott at 7:54 AM on October 15, 2007 [8 favorites]

Plus, if it's not actually illegal how is it actually law breaking? I mean just because doing X may be as enjoyable (or enjoyable in the same manner) as doing something illegal it's the same as doing something illegal.

It's certainly illegal to have the prescription drugs without a prescription, and there's probably different bits of illegality in the various ways of obtaining a prescription when you just want to get high.

I think the article is valid. American society and politics present getting high as something that should be illegal except for alcohol and tobacco - and here's how, whether or not it's technically illegal, people are performing an end run around the laws against getting high, by popping their Xanax or whatever.

It's like if listening to music was illegal except for a loophole where if you downloaded Creative Commons music it was legal or unenforced. A way to get around the law.
posted by TheOnlyCoolTim at 7:56 AM on October 15, 2007

delmoi writes "His argument on 'prescription drug abuse' is idiotic. According to his logic, nicotine and cocaine are the same because they act on the brain via the same mechanism. But come on, they are not the same. "

You are not reading what the article said:

another part is the widespread public acceptance of the idea that the effects drug users have always been seeking in their illicit drugs—calmness, lack of pain, and bliss—are now "treatments" as opposed to recreation. We have reached a point at which it's commonly understood that when people snort cocaine because they're depressed or want to function better at work, that's drug trafficking; but taking antidepressants for similar purposes is practicing medicine.

I'm sure you've heard the term "self-medicating." It's a bit of pop psychology, to be sure, but there is some truth to it. Problem still remains, however, that recreational drug use is considered taboo and is therefore criminalized.
posted by krinklyfig at 7:57 AM on October 15, 2007

Illegal parking in neighborhoods
Drug deals in neighborhoods

as opposed to where, deserts?
posted by jonmc at 7:57 AM on October 15, 2007

As much as we balk at the notion of all laws being enforced to the fullest extent possible, such a policy would have one notable effect : fewer stupid laws.

I'd think that speed limits and marijuana prohibition would be among the first to go.
posted by Afroblanco at 8:02 AM on October 15, 2007 [1 favorite]

according to some surveys, 70 percent of men have admitted to visiting pornographic sites at some point.

And the remaining 30 percent have lied about it.
posted by Astro Zombie at 8:03 AM on October 15, 2007

I'd think that speed limits and marijuana prohibition would be among the first to go.

Dude, slow down.
posted by Pollomacho at 8:03 AM on October 15, 2007 [2 favorites]

Illegal parking in neighborhoods
Drug deals in neighborhoods

as opposed to where, deserts?

Well illegal parking at parking meters seems to get ticketed might fast around here. But park abandoned, stolen, or huge commercial vehicles in a residential neighborhood, and nothing happens. Even with large amounts of yelling.

Ditto with the drug deals. No amount of reporting gets any action.
posted by Red58 at 8:10 AM on October 15, 2007

So you can park wherever you want and buy drugs? Can you let me know where this neighborhood is?
posted by ND¢ at 8:14 AM on October 15, 2007 [3 favorites]

Inside the DC city limits the problems differ slightly from Red58's list. Park a car in the wrong spot or for a fraction of a second too long and blam-o you get served a parking ticket. Try to change out that old tile in your town house and wha-cha you get served a building-code violation. Forget the lid on your super-can, ka-blam-o, served. Take a swig of your drink on the Metro, badda-bing, you got it.

But use or deal crack openly in the street? Mug people? Shoot a four year old through the front window of her house? Burn down several town houses? No problem!
posted by Pollomacho at 8:17 AM on October 15, 2007

American society and politics present getting high as something that should be illegal except for alcohol and tobacco - and here's how, whether or not it's technically illegal, people are performing an end run around the laws against getting high, by popping their Xanax or whatever.

There are no laws against getting high. There are laws against possession of certain substances, and distribution of certain substances -- because it's been successfully argued that the risks associated with those substances are, for whatever reason, too great to allow unrestricted access to them.

But anything that's not expressly forbidden is permitted. Getting high has always been allowed. I'll grant you though, that the desire to stop other people from doing so does seem to be a deeply ingrained trait in the American puritan psyche.
posted by PeterMcDermott at 8:33 AM on October 15, 2007

this article is a big whatever. i dont buy the argument that the "dead zones" in the law correspond to where the legislature is out of touch with society.

i think its much more obvious that all of the law is a dead zone... almost every single law is set up to be selectively enforced, and who it gets enforced on is telling in and of itself. in other words, you set everybody up as a criminal, and then you can fuck with whoever you want. its the perfect mechanism for govt control.

which is why, if the author had considered, say, the different experience of people of color in this country when it comes to drug laws, he'd see that these (and most) laws are on the book for very nefarious reasons, not as a legislative "oversight".
posted by mano at 8:45 AM on October 15, 2007 [6 favorites]

There are no laws against getting high. There are laws against possession of certain substances, and distribution of certain substances -- because it's been successfully argued that the risks associated with those substances are, for whatever reason, too great to allow unrestricted access to them.

Not quite. Check out the "Terms and Conditions" on a product some time. Next time you have a can of spray paint look for the label that says, "It is a violation of Federal law to use this product in a manner inconsistent with its labeling."
posted by Pollomacho at 8:50 AM on October 15, 2007

ND¢: Does the risk of those consequences outweigh the reward of the activity itself?" and that calculation can't be accurately made if your thought process stops at "This is illegal, so there is a large risk that I might go to jail. I will not do that."

Why, that almost sounds like people are choosing to obey laws according to the punishment meted out instead of out of a sense of civic responsibility! Gasp! Shock!
posted by JHarris at 8:58 AM on October 15, 2007

This guy seems to have a weird theory of laws. He seems to think they exist to keep people from enjoying themselves. But the point of laws is to keep people safe. Since "legal" drugs pose no danger, unlike (supposedly) illegal drugs, they are legal.
posted by delmoi at 9:02 AM on October 15, 2007

"It is a violation of Federal law to use this product in a manner inconsistent with its labeling."

I can't find any Federal laws against paint huffing, though it does appear to be illegal in Wisconsin. Huffing and driving seems to be a perfectly legal activity in some parts as well.
posted by PeterMcDermott at 9:08 AM on October 15, 2007

Since "legal" drugs pose no danger, unlike (supposedly) illegal drugs, they are legal.

Ah, yes, so it wasn't the vioxx that geve my dad that heart attack! Thank goodness!
posted by Pollomacho at 9:08 AM on October 15, 2007

Since "legal" drugs pose no danger, unlike (supposedly) illegal drugs, they are legal.

You can overdose on everything up to and including acetaminophen, and marijuana has a safety record that would be the envy of most legal drugs.
posted by Pope Guilty at 9:13 AM on October 15, 2007

The money quote, for me, from the introduction:

Tolerated lawbreaking is almost always a response to a political failure—the inability of our political institutions to adapt to social change or reach a rational compromise that reflects the interests of the nation and all concerned parties.

Hm, political failure. There seems to be a lot of that going around lately.
posted by JHarris at 9:23 AM on October 15, 2007

I spent a year working in a federal courthouse, and I was always amused to see federal judges regularly and shamelessly jaywalking across the streets nearby.
posted by brain_drain at 9:25 AM on October 15, 2007

delmoi writes "Since 'legal' drugs pose no danger, unlike (supposedly) illegal drugs, they are legal."

Really? Morphine is legal. Amphetamines are legal. Oxycontin is legal. All prescription, of course.
posted by krinklyfig at 9:35 AM on October 15, 2007

delmoi writes "But the point of laws is to keep people safe."

Ah, poor, naive child. If only ... if only.
posted by krinklyfig at 9:36 AM on October 15, 2007

the 'political failure' thesis was interesting, but he went nowhere with it.

i would argue that the biggest political failures are the federal environmental laws (clean water act, 404 comes to mind). when whole companies of NPO's are formed merely to sue the government into enforcing the law, there's a political failure.

on the one hand, the environmental movement of the seventies was the most successful of the social movements, considering the movement won a federal agency devoted to the causes of fixing problems of pollution. On the other, there is no jail time for polluting the water or destroying wetlands, so all the energy spent getting the laws written and enforced may have been better spent furthering the movement for social change.
posted by eustatic at 9:46 AM on October 15, 2007

I spent a year working in a federal courthouse, and I was always amused to see federal judges regularly and shamelessly jaywalking across the streets nearby.

Y'know what's frigging weird? Going to a city where they actually take jaywalking seriously. Apparently they hand out tickets for it in Seattle. When I was there, all my friends were totally paranoid about crossing the street. And I'm from NYC, where jaywalking isn't just tolerated, it's necessary. You better believed I jaywalked the hell outta some Seattle, even if it meant having to wait on the opposite corner for my friends to catch up (which it oftentimes did).

They also have this retardiculous smoking ban in Seattle. Now, once again, keep in mind, NYC has one of the most prominent antismoking bans in the country, and it doesn't bother me in the slightest. In fact, I actually kinda like having bars be non-smoky. But in Seattle, you technically aren't allowed to smoke within 25 feet of any building. 25 frigging feet! I'm only an occasional smoker, and this pissed me off. Oh yeah, and the sage souls who wrote their smoking ban forgot to write in an exception for hookah and cigar bars. So a bunch of perfectly viable businesses had to shut down. Because people who go into hookah and cigar bars are obviously doing all they can to avoid second-hand smoke.

pshhht.
posted by Afroblanco at 9:53 AM on October 15, 2007

delmoi: But the point of laws is to keep people safe. Since "legal" drugs pose no danger, unlike (supposedly) illegal drugs, they are legal.

This attitude is almost as bad. Laws aren't for keeping us safe, they are for protecting our rights.

Now, bring on the drugs.
posted by spaltavian at 9:54 AM on October 15, 2007

What DU said. The TV show Cops pretty much shows where our priorities are.

And what you said, rolypolyman. That shit is scary. I hope it's not a very good sample. (I'm from West Oz and the cops aren't nearly as bad. Yet.)
posted by uncanny hengeman at 9:55 AM on October 15, 2007

I'm from West Oz and the cops aren't nearly as bad.

They are from what I've seen!
posted by Pollomacho at 9:58 AM on October 15, 2007

He seems to think they exist to keep people from enjoying themselves.

This country was founded by Puritans. Of course they do.
posted by oaf at 10:47 AM on October 15, 2007

Park a car in the wrong spot or for a fraction of a second too long and blam-o you get served a parking ticket. Try to change out that old tile in your town house and wha-cha you get served a building-code violation. Forget the lid on your super-can, ka-blam-o, served. Take a swig of your drink on the Metro, badda-bing, you got it.

But use or deal crack openly in the street? Mug people? Shoot a four year old through the front window of her house? Burn down several town houses? No problem!

No one makes a dime off of a dead four year old... but parking violations... that's where the mullah is at.

In simpler times we'd just raise income taxes... nowadays we fill our civic coffers with the dollars from victimless infractions.
posted by wfrgms at 11:10 AM on October 15, 2007

This country was founded by Puritans.
Jefferson, Madison, Adams, Washington, et al were not Puritans.


There are no laws against getting high.
Public intoxication
posted by Kirth Gerson at 11:11 AM on October 15, 2007

parking violations... that's where the mullah is at

Apparently your mosque is in a no-parking zone.
posted by oaf at 11:18 AM on October 15, 2007 [3 favorites]

This country was founded by Puritans.
Jefferson, Madison, Adams, Washington, et al were not Puritans.

Neither were the members of the London Company (nor frankly the founders of the Plymouth Company either).
posted by Pollomacho at 11:19 AM on October 15, 2007

It would be an interesting experiment to fully enforce every single criminal law on the books, with penalties to cops who don't. Jaywalking? Ticket. Traffic moving at a safe speed but at 75? Mass ticketing. Red light cameras at every intersection, automatic stopsign enforcement, millions of meter maids.

I'd bet that would either restore a certain amount of sanity to the lawmaking process or devolve into a police state inside of an hour. Or both, I suppose, if that's what enough people want.
posted by Skorgu at 11:22 AM on October 15, 2007

Jefferson, Madison, Adams, Washington, et al were not Puritans.

Right, but they came about a hundred and fifty years after its founding, so that's neither here nor there.
posted by oaf at 11:24 AM on October 15, 2007

And the remaining 30 percent have lied about it.

That was research! I was only pretending to look at internet porn.
posted by kirkaracha at 11:52 AM on October 15, 2007

Right, but they came about a hundred and fifty years after its founding, so that's neither here nor there.

Ah, I see that you're history-impaired. Never mind.
posted by Kirth Gerson at 11:59 AM on October 15, 2007

Ah, I see that you're history-impaired. Never mind.

Ah, I see that you're history-impaired and a hypocrite. Never mind.
posted by oaf at 12:04 PM on October 15, 2007

(Do you really think that Jefferson was around in the early 1600s?)
posted by oaf at 12:04 PM on October 15, 2007

Do you really think the United States was founded in the 1600s? Maybe you should read this.
posted by Kirth Gerson at 12:31 PM on October 15, 2007

Then you can read this.
posted by Kirth Gerson at 12:34 PM on October 15, 2007

Do you really think the United States was founded in the 1600s?

Its legal and cultural tradition? Absolutely.
posted by oaf at 12:45 PM on October 15, 2007

The problem with all these non-enforced and community eroded laws is that they can be wheeled out to harrass and prosecute oponents of people in power.

Thus they serve a useful purpose. If everything's potentially illegal, then you'd better do what the nice man at the top tells you, right?
posted by lalochezia at 12:45 PM on October 15, 2007 [1 favorite]

Then you can read this.

I think you mean this.
posted by oaf at 12:46 PM on October 15, 2007

Do you really think the United States was founded in the 1600s?

Its legal and cultural tradition? Absolutely.

A country is not founded when some people land on a shore and claim it for some other country. It is not founded when those people adopt (or import) a legal tradition or culture. A country is founded when an independent government is established. You can look it up, but you probably won't.
posted by Kirth Gerson at 12:59 PM on October 15, 2007

Founding Parents.
posted by Pollomacho at 1:00 PM on October 15, 2007

Kirth, don't talk down to me. It makes you look silly.
posted by oaf at 1:05 PM on October 15, 2007

Don't keep making blatantly ridiculous assertions, and I'll stop trying to explain things to you.


As Patrick Collinson has noted, well before the founding of the New England settlement [the word] “Puritanism had no content beyond what was attributed to it by its opponents.”
posted by Kirth Gerson at 1:11 PM on October 15, 2007

There are no laws against getting high.
Public intoxication

If that were the case, the law would just be called "Intoxication". So it seems like it's the public part, not the intoxication part, that's illegal.
posted by BitterOldPunk at 1:12 PM on October 15, 2007

Don't keep making blatantly ridiculous assertions, and I'll stop trying to explain things to you.

In order to keep doing something, I would have to have started to begin with. There's no need to explain to me what I understand. Especially if you don't.
posted by oaf at 1:13 PM on October 15, 2007

(Your ability to split hairs does not make you right.)
posted by oaf at 1:14 PM on October 15, 2007

The people that established colonies on the shores of America that were governed by a central executive and a legislative body were the founding fathers by the definition provided here. True, Elizabeth's colonies failed, but James suceeded as did those of his sucessor Charles (None of whom were Puritans). Some of the legislative bodies established then exist today, now independent of the Monarchy under which they were founded. Some of them happened to band together with other bodies formed later and together they formed their own central government independent of that monarchy.

To say that George Washington founded the legislation of Virginia or the Province of Maryland or that the Declaration of Independence was the foundation of legislative democracy in America is patently false. To say that the self-reliance and self-governance (as well as a system of religious tolerance) long established in those colonies lead late 18th century statesmen to believe that they could operate fully seperate from the monarch would be more accurate.
posted by Pollomacho at 1:31 PM on October 15, 2007

So, you're arguing that a colony is a country?
posted by Kirth Gerson at 1:36 PM on October 15, 2007

So, you're arguing that a colony is a country?

No, but the legislatures established in those colonies in the early 1600's (that still exist as State legislatures) were the roots of the United States. What came in 1776 was an extension of what was already happening.
posted by Pollomacho at 1:54 PM on October 15, 2007

Is a derail founded when it begins or when it is officially labeled as such?
posted by brain_drain at 2:10 PM on October 15, 2007 [1 favorite]

good god, people.

at the same time the puritans were doing their thing in (what was to become) new england, there were anglicans in (what was to become) the middle colonies and a whole bunch of folks in (what was to become) the southern colonies.

it wasn't just the puritans! the reason people think they "founded" this country is because people like cotton mather and his 17-gajillion children kept good journals. we have more written record from the puritans than other groups. that doesn't mean they were the sole founders of the nation.

all it means is that they really embraced their protestantism, and therefore had higher literacy rates. and therefore wrote more. and stuff.

i agree that the country wasn't "officially" founded until the "official" government was established, etc. the puritans were not the only group whose traditions were assimilated into the larger burgeoning american culture. they just get all the credit.
posted by CitizenD at 2:11 PM on October 15, 2007

So you can park wherever you want and buy drugs? Can you let me know where this neighborhood is?

North Philadelphia?
posted by The Straightener at 2:37 PM on October 15, 2007

cotton mather and his 17-gajillion children

His father was named Increase. Increase.
posted by oaf at 3:42 PM on October 15, 2007

Hey, how did this otherwise good thread become a pissing contest between a few users?

Quit it, guys. You're annoying me.
posted by Afroblanco at 3:50 PM on October 15, 2007

Quit it, guys. You're annoying me.

Is there a law?
posted by oaf at 3:59 PM on October 15, 2007

No, but there is enforcement.
posted by LooseFilter at 4:20 PM on October 15, 2007

Is there a law?

Do you need one?
posted by loquacious at 4:22 PM on October 15, 2007

As a former pharmacist, I can attest that the Wired article is ABSOLUTELY TRUE, though it missed a couple of important points.

There is in this country a GIGANTIC prescription fraud problem, simply in the form of scumbags stealing doctor's prescription pads and/or phoning in phony prescriptions. I would catch these assholes sometimes, and inevitably, when I would fill out a police report, NOTHING WOULD EVER COME OF IT. Unless you work in a pharmacy, you have no idea how large and rampant a problem this is, and the police and courts do virtually NOTHING about it. It's something that you won't see on 60 Minutes, or read about in your local newspaper. Trust me, it's a GIGANTIC source of illegally gotten prescription drugs.

The other great issue, and I'm sure this will be an unwelcome thought to some here, is that for a huge number of people on welfare, getting high on prescription drugs is more or less a religious passion. In the state of Washington, people on welfare get their drugs for free (no co-pay). Some of these people absolutely LIVE for their Vicodan and/or Soma. Of course, most of them can't or won't actually articulate the word "Vicodan", as for some reason they always pronounced in the plural. Used in a sentence, it might sound like this; "I lost my Vicodans on the bus, and I needs a refill. Call my doctor for me"...

I used to work in a pharmacy in Burien, Washington, which was located not far from Highline hospital. Every weekend I would see a huge spike in welfare prescriptions for Vicodan, Soma, and Percocet, all coming from the ER. You see, the welfare types figured out that if they go to the ER on the weekend with some bogus injury complaint, the ER docs would usually "give in" by simply accepting their story and give them enough buzz drugs "until they could see their regular doctor", as their regular doctor would not be there on the weekend...

Years before the World Wide Web, I would puzzle over how these people as a class, would all know what doctors to go to, what bullshit stories to tell, what times and places to request drugs, and all the rest. How did this meme spread? Was there a bulletin board they all frequented? How did they all know to go to Highline ER on the weekends and complain of back pain?

If you feel my opinion is atypical, please visit this blog.

This guy's blog is so right on the money, it's actually too painful for me to read most of the time.

Yes, ladies and gentlemen, BILLIONS of your tax dollars fund welfare scum's taste for getting high on Vicodan, Soma, and Percocet.

I should like to state outright that of course not all individuals on welfare are like this, BUT A WHOLE LOT OF THEM ARE...
posted by Tube at 4:44 PM on October 15, 2007

Results 1 - 100 of about 82,700 for vicodan.

Results 1 - 100 of about 8,260,000 for vicodin.
posted by marble at 5:35 PM on October 15, 2007

The Angry Pharmacist rocks. Thanks, Tube.
posted by Faze at 6:50 PM on October 15, 2007

And the side of the problem that Tube complains of is that any legitimate pain patient gets *perceived* by people like him as a scammer and/or addict so the vast majority of doctors won't prescribe opioids long term for anyone in chronic pain.

Tube, how do you know who is really in pain? Do you have a "painometer"? If you have one, could you please patent it because in the real world, there is actually no way of knowing how much pain someone is in other than asking them.

Would you prefer that people in real pain get no meds in a vain an attempt to deny the scammers the meds they will obtain anyway from either corrupt people, nice people who want to err on the side of the angels (ie believing pain rather than denying it) or actual drug dealers?
posted by Maias at 7:27 PM on October 15, 2007

I don't think he thinks it through that far. He's just stressed, angry, and sick with downward envy.
posted by aeschenkarnos at 8:29 PM on October 15, 2007

Tube, how do you know who is really in pain?

I included a statistically demonstrable example in my comment about spikes in ER scripts for painkillers and Soma as an example of overt fraud, which is what I'm talking about.

Blame has to fall on corrupt doctors, too. For many years Seattle had a doctor whose prescriptive authority for controlled substances had been stripped by the DEA. Yet his MD license was still valid. ALL he ever prescribed was Soma, and most of this was to DSHS (welfare) recipients. He worked out of his home, which was literally just up the street. I'm not proud to admit this, but the truth is that I continued to fill his prescriptions for Soma. I knew deep down that the chain that I worked for would not back me up if it came to a conflict if I chose to not fill his Soma prescriptions.

As you may have figured out by now, Soma (carisoprodol) is a muscle relaxant which is NOT a controlled substance, and so does not require a DEA licence to prescribe. But it's for sure a buzz drug, a clean downer. Many years passed before the state FINALLY stripped this guy of his prescriptive authority.

I must have filled 100,000 hits of generic Soma for welfare people while I worked there, all from this ONE doctor. Yes, that amounts to shitloads of tax dollars all spent just to let welfare people get high.

I've seen it happen with other doctors, too. At a different pharmacy I worked at we had this one asshole MD who liked to prescribe methadone in quantities of 100 to 200. For some reason, and I kid you not, this would occur on Saturday mornings. I'd get into work and 2 or 3 welfare dudes in line would clean us out for methadone. The last I heard the corrupt MD had a warrant out for his arrest, and had fled the jurisdiction.

So the real answer to your question is by observation of long term patterns and behaviors by doctors and patients. It's part of the real-world expertise that one gains on the job, an intuition backed up by real-world statistics.

Yes, this subject does make me angry. Like driving or shaving, posting on the Internet is not something one should do while angry. Acting in haste, I did not double check my work, and indeed misspelled "Vicodin".

Oh yeah, one more thing. We would catch these guys on DSHS scamming us with phony or stolen scripts and I would report them to DSHS, as they were also scamming DSHS by getting their drugs for free. Washington DSHS doesn't do jack-fucking-shit about DSHS drug fraud. We would have these people cold, and even include police case numbers in our phone calls to DSHS. Nothing. No response. Ever.
posted by Tube at 9:34 PM on October 15, 2007

ALL he ever prescribed was Soma, and most of this was to DSHS (welfare) recipients. He worked out of his home, which was literally just up the street.

Some doctors specialize in pain; some people on welfare have chronic pain issues.

Look, you may be right that some or even most of the people you're complaining about were addicts. But quite frankly, it's not a huge financial burden on the system (not at Vicodin prices, anyway, I have no idea what Soma costs), and I think that's a fair price to pay to make sure that people who are in significant pain can get the meds they need. Your judgment isn't necessary, thanks.
posted by spaceman_spiff at 9:43 PM on October 15, 2007

Besides which some of the people on welfare are probably there because their chronic pain interferes with their ability to hold down a job with benefits. It's not hard to imagine a person with physical skills injuring themselves, not being able to work and then declaring a medical bankruptcy, might be on welfare while still unable to work.

Even assuming for the sake of argument that 90% of the scripts you were filling were people looking to get high. How do you separate those people from the 10% who aren't? Or do you just tell that 10% to go pound sand, the system isn't going to help you?
posted by Mitheral at 12:29 AM on October 16, 2007

I've seen it happen with other doctors, too. At a different pharmacy I worked at we had this one asshole MD who liked to prescribe methadone in quantities of 100 to 200.

100 to 200 5mg tablets? Given that the recommended daily dose for someone getting maintenance treatment is between 60 and 120 mg. That's what, a week to ten days supply?

Outrageous.
posted by PeterMcDermott at 1:15 AM on October 16, 2007

Some of these people absolutely LIVE for their Vicodan and/or Soma.

Wait, wait. They actually manufacture and sell a drug called Soma in the US, now?

That's the funniest thing I've seen all damn day. Well, by funny, I mean... well, I don't know what I mean, exactly.
posted by stavrosthewonderchicken at 1:22 AM on October 16, 2007

liked to prescribe methadone in quantities of 100 to 200

I just gotta come back to this post by tube, because for me, it illustrates so much of what's wrong with the USA today.

The British govt -- through it's drug treatment arm, the National Treatment Agency -- has just undertaken some work on methadone. Two pieces that have a bearing here. Firstly, it commissioned the National Institute for Clinical Excellence to do a technology appraisal of the value of methadone and buprenorphine in the treatment of drug dependence. NICE an independent body charged with reviewing the evidence on certain treatments in order to help determine their value in cost/benefit terms and make recommendations to the NHS.

NICE finds that as a treatment for chronic opioid dependence, methadone maintenance works. Works pretty reliably, and better than most everything else. Demonstrable positive effects in terms of health, crime, social functioning, etc. etc. Defines the therapeutic doses as between 60mg and 120mg a day. A very small number of people might need a little less, or a little more, but 90% of your treatment population will do fine on these doses.

In NHS terms, that has the force of law. Every area in England (I think that since devolution, NICE only covers England) has to make those treatments available to people who meet the criteria for clinical need.

Second piece of work was a re-examination of the 'Orange Guidelines' -- The Clinical Guidelines for the Management of Drug Dependence. The first piece of work was obviously designed to inform the latter. A much more inclusive process, this sits all of the clinical stakeholders and some patients around a table, they look at the research and current practice and attempt to come up with something that looks like best practice. Unlike the NICE stuff, the Orange Guidelines cover the whole of Britain. They are only guidelines, but if your practice differs widely from that, at some point, someone will start asking questions as to why. Then, you can say hello to General Medical Council disciplinary proceedings.

Of course, the Orange Guidelines adopt NICE's recommendations. Why wouldn't they? They're doctors -- the bulk of them. They understand that the thing that makes their voodoo shit work is the science behind it. So even those places that have traditionally been extremely religious and puritanical, like Scotland and Northern Ireland, have adopted them.

And what do they say? Well, beside the 60-120 mg daily dose, they reaffirm a commitment to the role of General Practitioners treating their drug dependent patients. They'd prefer it if they got a bit of training, but it isn't rocket science, so it isn't compulsory. If you're seeing a whole lot of addicted patients, you'll probably be wanting to contact your local Drug Action Team, because they can help out with money, resources, a counsellor, so that your patient can get a bit more than the five minutes or so that General Practice patients generally have allocated to them.

Now, there are a couple of things that our 'corrupt doctor' in Seattle is doing that could fall outside the guidelines. For example, for the first three months or so, they should be on supervised consumption to ensure some degree of compliance with the regime. You don't get the benefits if you don't take as directed. Also, they should be on mixture rather than on tablets. But I'm guessing that these facilities just aren't available to the average Seattle General Practitioner, so you do the best you can with resources available to you.

So what's my point? Well, this doctor might be a corrupt asshole. Or alternatively, he might be a caring doctor that's seeking to do the best for his patients by providing them with treatment that is consistent with the available international research evidence, but actually happens to go against the current political grain.

But even if it *is* the latter, it really doesn't matter much, because the US has trained a whole army of spies and bureaucrats who are determined to police the medical practice of anybody who happens to be sympathetic, empathetic, and more concerned with the needs of his patients than he is with the needs of a theocratic state. So our caring, sharing clinician will no longer have his medical practice judged by those who are best qualified to judge it as it would be in the UK or elsewhere, the DEA now subverts that process by sending in a couple of junkies facing jail time in an attempt to get treatment out of him. When one of them finally makes a score, the poor bastard gets arrested and dragged into the criminal justice system, where they know nothing of the evidence regarding the treatment of pain relief or drug dependence -- all they know is, 'Drugs are bad... m'kay?' and the poor bastard loses everything, and gets a five year prison sentence to boot.

NICE Technology Appraisal
Orange Guidelines (PDF)
Maia Szalavitz on policing pain medicine.
posted by PeterMcDermott at 3:22 AM on October 16, 2007 [2 favorites]

Tube's comments are anecdotal (his own prejudiced experiences), borderline racist (why mention how these people speak, or the fact that they may use public transit?) and certainly classist (because they may be on welfare, they don't deserve access to prescription medication?)

Tube, your comments are viciously ignorant, do not advance the discussion, and are frankly mean spirited.

Please go fuck yourself.
posted by wfrgms at 5:19 PM on October 16, 2007

tube: There is in this country a GIGANTIC prescription fraud problem, simply in the form of scumbags stealing doctor's prescription pads and/or phoning in phony prescriptions. I would catch these assholes sometimes, and inevitably, when I would fill out a police report, NOTHING WOULD EVER COME OF IT. Unless you work in a pharmacy, you have no idea how large and rampant a problem this is, and the police and courts do virtually NOTHING about it. It's something that you won't see on 60 Minutes, or read about in your local newspaper. Trust me, it's a GIGANTIC source of illegally gotten prescription drugs.

I don't see the problem. Are we going to run out of painkillers or something?
posted by spaltavian at 12:15 PM on November 1, 2007