David Borden, Executive Director, email@example.com, 10/3/03
This week I find myself in the unexpected position of defending -- or pointing out a possible defense for -- conservative talk show host Rush Limbaugh. I have never been a fan of Limbaugh; I would not be even slightly upset or sentimental if his show were to go away and drift forgotten into the past. I'm not an ESPN viewer, but if I were, I wouldn't have been sad to see him leave that post either. I did have fun several years ago helping a producer at ABC's Peter Jennings find a Rush sound-bite about the "potheads" calling up the show to talk about medical marijuana.
This week the news networks noted the controversial Limbaugh had gotten bad news not once but twice. The first was the comment about NFL quarterback Donovan McNabb which led to his ESPN resignation. But the second one is the more interesting, and the more potentially destructive to his career and personal freedom. Limbaugh has apparently been implicated as a regular customer of a drug ring selling illegally diverted supplies of the narcotic oxycontin.
I'm a legalizer, and I firmly believe that if Rush Limbaugh wants to pop oxy, it's not the business of the criminal justice system, so long as he doesn't violate the safety or property of other people. Limbaugh himself chimed in on the issue, apparently on the legalization side, in March 1998, as part of a response to a caller who was wondering why they didn't go after alcohol as aggressively as states' attorneys general were going after tobacco with the lawsuits (http://www.ndsn.org/marapr98/legal1.html). Among other things, Limbaugh replied, "It seems to me that what is missing in the drug fight is legalization. If we want to go after drugs with the same fervor and intensity with which we go after cigarettes, let's legalize drugs."
Naturally this week's incident has revived discussion of the Limbaugh legalization quotes on discussion groups inhabited by long-time drug reformers. But it has also prompted speculation amongst people concerned with the problem of under-treatment of chronic pain and the growing wave of inappropriate prosecutions of physicians specializing in pain management (a topic that coincidentally is the subject of this issue's lead news story, as well as last week's editorial and lead story and other recent editorials and reports).
Dr. Frank Fisher, a leading authority on pain control who is in the late stages of soundly defeating one of those prosecutions, commented, "This seems like a whole lot more pills than Rush would need if all he wanted to do was get high, but it is within the range that might be used to treat chronic pain." Fisher also noted, "The large numbers the story talks about getting diverted from a pharmacy lends credence to the idea that much of the overall diversion of pharmaceuticals does not come from bad doctors running pill mills. Think about it. If you were a desperate patient willing to be treated at a pill mill, do you think you could find one?"
One of the spouting heads on CNN last night was a DEA agent named Joe Kilmer, claiming Oxycontin is "four to five times as strong as heroin." I thought that sounded like bull, and Dr. Fisher confirmed for me that my instincts were on target. "Milligram for milligram," Fisher wrote back, "oxycodone and heroin are of similar potency. Heroin is essentially morphine, and the conversion factor when switching from one to the other regards oxycodone as at most twice as potent, depending on whom you ask." For good measure he sent me a conversion chart showing the equivalency rate as 1:1. It's not surprising that Kilmer would spout such a falsehood, though, given that it was the DEA which fabricated the so-called "epidemic" of Oxycontin abuse to generate the currently prevailing hysteria over the useful pain reliever.
CNN should have been a little more thoughtful in their choice of commentator on that. Why give the five seconds available to a cop? Put someone on like a doctor with legitimate credentials in the subject. Knight Ridder Newspapers were similarly uncritical in an article released yesterday on the allegations. The Ridder article reprinted a quote -- originally published in the National Enquirer -- from Limbaugh's former housekeeper, claiming she had supplied Limbaugh with "enough [pills] to kill an elephant, never mind a man." But what does a housekeeper or a police officer know about the physiology of taking Oxycontin, for pain or otherwise, or what number of pills are safe for a given individual or needed to produce the intended effect? The article also noted that she was working with authorities as part of an investigation, presumably to avoid or soften a prosecution against her -- a red flag to make one wonder what kind of pressure she may getting from authorities to say such things.
I don't know whether Limbaugh is innocent or guilty of illegally buying oxy, or if so if he was taking it for pain, for addiction, or for fun. But in any of these cases, the correct solution to the problem lies in the set of possible policy approaches that fall into the legalization category. Limbaugh's possible dealers may well be highly unsavory people, but to a pain patient desperate for treatment because his doctor is too scared of the government to prescribe it, their services are as valuable as those of the people running the nonprofit cooperatives supplying medical marijuana. For an addict who is otherwise going to buy street heroin, at risk of poisoning or unexpectedly high purity causing overdose, diverted but legally produced oxycontin or other opioids may be the thing that saves his life. And for the casual user -- a scenario which admittedly seems unlikely in this case as well as risky with this particular drug -- there was never a reason to worry much about them in the first place, other than to make sure they know what the necessary precautions are that they need to take to avoid overdosing or getting addicted -- and legalization with provision of harm reduction information is the way to go in those cases too. Better to get the drugs off the street, into a pharmacy or other appropriate legitimate establishment, let the addicts know what they're getting and get it at a reasonable price and in a safe environment, and allow pain patients and their doctors to deal with these difficult and complex medical problems without having to worry about heavy-handed government interference in their business.
So criticize Limbaugh for the things he says, I'm sure I'll agree with those criticisms a pretty large percentage of the time. But when it comes to Oxycontin pills, I say, let the man have them, if that's the situation, and let him alone about it.