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OxyContin news
Question:
I can tell you what is starting to happen to rheumatologists at > least here in Philly. One of the Medicaid managed care plans > now requires prior authorization for Oxycontin and will only > give Oxycontin without prior authorization for patients with > cancer or sickle cell anemia. Other plans will only let you write a > every 12 hour dose unless you are a pain management specialist. > This I discovered on Thursday when a patient who I had > nicely titrated on every 8 hour dosing because that it what > worked for the patient found that the pharmacy would not fill my > script. But apparently a pain doc can be more flexible with dosing > than I can, as a rheumatologist.
In light of that recent insufficient pain medication lawsuit in California I can see how doctors might be feeling a little nervous. "We’re not going to give you discretion to prescribe medication to control pain, but if you fail to do it then we’re going to nail you with big damages." I find it very disconserting that doctors are being jerked around like this. There are other concerns that should be higher on their list of priorities. > Meanwhile, you can buy whatever you want on the streets of > Philadelphia but if you have RA or OA or spinal stenosis or > osteoporotic compression fractures or fibromyalgia, you have to > prove that your pain is equally worthy to the pain of cancer or > sickle cell anemia.
Personally I get the impression that they’re going overboard in the process of trying to "nip this thing in the bud". The fact that there are immature people who abuse these things is terrible, but somebody went to a lot of effort and expense to research this magnificently effective new medicine, and now federal regulation is standing in the way of its benefits being delivered to the patients it was invented to help. Is there anyone besides me who could imagine a bang-up "60 Minutes" segment on this little paradox? > Do you ever wonder why so many rheumatologists, myself included, > are thinking about retiring?
I hate to break it to you, doc, but we’re *all* thinking about retiring. ;) We just aren’t doing it because we’re concerned that we’re doomed to be sued out of business. 
Very seriously, what should I do to help? Who do we need to influence, and to whom do they report? The reason I ask is that I’m guessing these are the people who are going to decline to be interviewed by Mike Wallace.
Response:
> Come on DEA get a grip!!!
Absolutely. This is all so stupid. I think we should go another ridiculous step and ban kitchen knives. After all, enough of people die from THEM every year! Just imagine! The Kitchen Knife Kops (KKK!)! We can all go back to finger food and ripping our steaks apart by hand! And then the only people to have kitchen knives would be the outlaws! — "Do not be alarmed. Sometimes our feelings conflict with our programming." –Android 16 (Dragonball Z) http://www.geocities.com/SoHo/Nook/9300
Response:
I just lurk most of the time, but I have to ask a question about this article… Wouldn’t rheumatologists be classified as "other doctors who regularly deal with chronic pain?" I’ll need to read the article thoroughly, but with the little tidbits I’ve read here there is no problem because my rheumy could still prescribe it Am I missing something? Lynette. – Hide quoted text — Show quoted text – > There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
Response:
> Hi Nathan, > The answer to that is simple. Write your Senators & Congresspersons.
In this case I was actually hoping for something slightly more direct to the committee or whatever governing body is behind the policy. I get the impression sometimes these days that there are committees of faceless bureaucrats who make these sorts of stupid decisions without ever having to answer to any elected official. > http://www.house.gov/writerep/ > http://www.Senate.gov/Senator/membmail.html > http://www.uncle-sam.com/ > Maybe the ACLU might be able to help. > http://www.aclu.org
Hmmm. I respect the ACLU, but I suspect this is outside their scope. Firing scattergun salvos of angry opinions at Congress-people is fine for some people, but what I had in mind was something more along the lines of calmly telling those faceless bureaucrats that we’re going to circulate their names and email addresses, and place their acts out in public view so that everyone can know exactly who it is that’s promoting this particular dumb idea. I’m sure that my congress reps would agree that this is a terrible policy. I just want to make sure we shine the light of day on the correct people.
Response:
Nathan, best bet is DEA and FDA and your own rep. Here are links Ive posted a coupla times. Painlinks.org is setup to help facilitate people who want to get involved in this issue. http://painlinks.org and http://painlinks.org/writeto..htm you will find contact info (call if you can) for the DEA, FDA, and every US Senator, and links to ascertain the name of your US Congressperson. For a sample letter (try to add your own views and feelings rather than mailing copies of other letters – but use other letters to get a basic idea of how/what to write can be found at http://painlinks.org/writeto..htm#Sample%20Letter For news media updates go to http://painlinks.org/oxyc2.htm Go to it. johnie
Response:
Lynette, If I were a physician (any physician) it would anger me to have my ability to practice limited by law/government. It’s bad enough that today medical practice is dictated to by insurance. If you start looking for "who qualifies", and relax because this doesn’t apply to you (figuratively), then for whom next does the bell toll? Every physician regularly treats people w/chronic pain. Bet on it. Toni
Response:
Hi Nathan, The answer to that is simple. Write your Senators & Congresspersons. http://www.house.gov/writerep/ http://www.Senate.gov/Senator/membmail.html http://www.uncle-sam.com/ Maybe the ACLU might be able to help. http://www.aclu.org GramPaHugs, Alex, > Very seriously, what should I do to help? Who do we need > to influence, and to whom do they report? The reason I ask is > that I’m guessing these are the people who are going to decline > to be interviewed by Mike Wallace.
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Response:
> Nathan-I think a "60 Minutes" or "20/20" segment on this issue would be > marvelous. > And it might well, help to calm the hysteria. > Char > "Remember, I’m pulling for ya’. > We’re all in this together." Red Green
Hhhm, But will it calm the greed of lawyers which are suing both sides until their bank accounts are full. Up, up go the costs of medicine and insurance. The patient is becoming as child education where other things are more important than pain and/or learning enough to have a secure future. Both topics are so big in scope that discussion soon mires down to side issures which ends up making someone wonder what the hell they were talkinga about to begin with. So it goes. Harv
Response:
- Hide quoted text — Show quoted text -> There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky > I wonder how many realize that if the FedGov were made to live by > the language in The Constitution, this would not be the case? > Regards, > Frank > "Good intention will always be pleaded for every assumption of > power. . . . [T]he Constitution was made to guard people against > the dangers of good intentions. There are men in all ages who > mean to govern well, but they mean to govern. They promise to be > good masters, but they mean to be masters." -D. Webster > and > "It is not the function of government to keep the citizen from > falling into error; it is the function of the citizen to keep the > government from falling into error." -Justice R. H. Jackson, > SCOTUS
Oooh my Well said but it is getting a little away the squeeze being put on doctors or is it? Maybe it is the squeeze and we only need more controls and laws(made by lawyers) to handle the problem. Now I know its getting away from a persons ability to get to work and do their job or even be a little more able to take care of themself when work is not possible. Harv
Response:
- Hide quoted text — Show quoted text – > There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
I wonder how many realize that if the FedGov were made to live by the language in The Constitution, this would not be the case? Regards, Frank "Good intention will always be pleaded for every assumption of power. . . . [T]he Constitution was made to guard people against the dangers of good intentions. There are men in all ages who mean to govern well, but they mean to govern. They promise to be good masters, but they mean to be masters." -D. Webster and "It is not the function of government to keep the citizen from falling into error; it is the function of the citizen to keep the government from falling into error." -Justice R. H. Jackson, SCOTUS
Response:
Hi Harvey. The term investors use for this, and other methods of generating a flow of finance from a situation (some they generate themselves, some their ‘friends’ generate) is ‘Value Extraction’. As in all things, follow the money trail and 99% of the time you’ve got yer culprit. Whenever something like this is going down, all you need to do is ask, who benefits from this? The only effective action against the causes is to make it too expensive/public for them, and, like the insects they are, they will scuttle away to someone else’s back yard and start a new colony there. The main problem today is that they are now infesting the very establishments you and I depend on to live. The above from Mike, (Top-posted to save you scrolling-pains) in response to Harvey R.Stone who wrote… <><><><><><< >Hhhm, But will it calm the greed of lawyers which are suing both sides >until their bank accounts are full. Up, up go the costs of medicine and >insurance. The patient is becoming as child education where other >things are more important than pain and/or learning enough to have a >secure future.
(All of this in the opinion of) Mike {Cing of Klangerz} {Buggy Technician by appointment to the Royal Realm of W.H.I.N.E} ("It ain’t what you are, but who you make of it that makes the difference!") WebSite filling up with links still at… http://www.mikeswebsite.pwp.blueyonder.co.uk/ Have a nice day. Its the law!
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Nathan-I think a "60 Minutes" or "20/20" segment on this issue would be marvelous. And it might well, help to calm the hysteria. Char "Remember, I’m pulling for ya’. We’re all in this together." Red Green
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Susan- I DO understand why you are considering retiring. But there are so many people out there that need you, to take care of them medically, and to care for them as people, and to fight for them when such things arise. I personally do not believe that limiting the use of oxycontin in patients, is going to affect how it is used on the street. And I also feel that there are many more drugs that are abused that need to addressed before this drug. Has their been an epidemic of oxycontin addicted babies? Can oxycontin be produced in a shed somewhere with ingredients that are readily available on the streets? Come on DEA get a grip!!! Char "Remember, I’m pulling for ya’. We’re all in this together." Red Green
Response:
Been to same surgeon for 25 years. Had both hips and one knee replaced. Been on Oxycodone and Oxycontin for 3 years, Indocin for 25 years. Last year, had 3 inches of colon removed for perforation. NOW, my surgeon will NOT prescribe any more pains med. Said go to gp. Went to gp, she won’t either. Having big problems with friend/surgeon. Staff lies to me, said surgeon shouldn’t be prescribing narcotics for post surgery. Guess I’m not making him any money, just the shots in the ankles ev. 3 months. Anyone else have this problem with their physician., I feel like going to the local medical society and making a complaint/ Maril
Response:
I wonder why it is that there has been no reaction from these departments until Purdue Pharma took over the production of these drugs. Could it have something to do with the political/corporate battles going on about just who should have how much money and from which budgets? USGov v Conglomo? Makes me think of that scene in RoboCop II where the MD of OCP is facing off the local mayor about finacial debt! Lets face it, the arguments, indeed the issue itself is relatively unique and makes me wonder what the *real* issues are here. The above from Mike, (Top-posted to save on scrolling-pains) in response to Becky Ratliff who wrote… – Hide quoted text — Show quoted text ->There is a very disturbing article at USA Today regarding the DEA and the >OxyContin controversy. Steve brought this to my attention a few days ago. >Since I haven’t seen any discussion of it here, I’m going to post the URL. >http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to >be believed, the DEA has asked the manufacturer to impose restrictions so >that only "pain specialists and other doctors who regularly deal with >chronic pain" can write prescriptions for this drug. Doctors should be >deciding what medications their patients need, not Washington bureaucrats or >drug company executives. It’s one thing to keep crack and LSD off the >streets. It’s quite another to interfere with legitimate access to >prescription medications. This shortsighted policy protects would-be >illegal drug users from their own folly at the expense of people who need >these medications. >Becky
(All of this in the opinion of) Mike {Cing of Klangerz} {Buggy Technician by appointment to the Royal Realm of W.H.I.N.E} ("It ain’t what you are, but who you make of it that makes the difference!") WebSite filling up with links still at… http://www.mikeswebsite.pwp.blueyonder.co.uk/ Have a nice day. Its the law!
Response:
Hi Becky, Thx for bringing that to our attention. Don’t know if this related story got much play – was a blurb in my paper today. Denise Jury Awards $1.5 M in Pain Case By MICHELLE LOCKE .c The Associated Press BERKELEY, Calif. (AP) – A jury awarded $1.5 million to the family of an 85-year-old man who accused his doctor of not prescribing enough pain medication during his final days. The verdict could be a turning point in the way physicians treat pain, medical ethicists said. “Any thought that people will not be able to prove lawsuits based on undertreatment of pain is misplaced. It’s a false comfort,” said Sandra Johnson, an attorney, law professor and provost of Saint Louis University. She is chairwoman of the center for Health Care Law and Ethics. “These lawsuits can succeed. It’s not a flash in the pan; It’s something I expect to see much more frequently, where the only loss to the patient is pain and suffering,” Johnson said. She said she knew of only one similar case, a $15 million judgment against a nursing home in North Carolina found to be negligent for not giving enough pain medication to a man dying of cancer. A California bioethicist says the award marks a turning point. “This case is the case that now says juries are prepared to hold physicians and acute care hospitals accountable for failure to properly manage pain,” said Ben Rich, a University of California, Davis professor of bioethics. The Alameda County jury ruled Wednesday that Dr. Wing Chin did not do enough to alleviate the pain of lung cancer patient William Bergman, a retired railroad worker who died in 1998. California law sets a cap of $250,000 on such judgments, meaning the award likely will be reduced. “It’s not really the money we were after,” said his daughter, Beverly Bergman. “We were after trying to get things changed and not having to have anybody go through what my father did again.” The Bergmans sued under California’s elder abuse statute. Barbara Coombs Lee, president of Compassion in Dying, an advocacy group that helped bring the lawsuit, said it was believed to be the first successful case charging a doctor with failing to administer sufficient pain medication under that law. Steve Heilig, a bioethicist and director of public health and education for the San Francisco Medical Society, said the verdict sets “an interesting precedent in that, historically, the medical boards, including in California, have pursued (penalties for) overmedication of pain. In this case, they’re reversing the standard, as it were, to undermedication. “My personal perspective is that there’s merit in that,” Heilig said. “Undermedication of pain is a big problem.” Jurors found elder abuse and recklessness in the case. However, they deadlocked on questions of whether Chin had acted with malice or had intentionally caused emotional distress. As a result, no punitive damages were considered. Chin declined comment after the verdict. His attorney, Bob Slattery, said the award may be appealed. During the trial, the defense said it was not clear Bergman had cancer. Defense lawyers said Chin did not prescribe morphine for pain because Bergman had an adverse reaction to the drug when he first was taken to the hospital emergency room. Kathryn Tucker, lawyer for the Bergmans, said Bergman had a tumor in his lung and abundant cancer symptoms. She said the family didn’t want a biopsy performed because they thought Bergman was too frail for invasive surgery. A spokeswoman for Eden Medical Center, the hospital where Chin has had medical privileges for more than 30 years, said the verdict was “surprising to the people who know him. Dr. Chin has devoted his entire career to caring for patients and most of them are seniors and therefore it’s difficult for those who know and work with him to accept the verdict.” Bergman’s family filed a complaint with the California Medical Board, but the board took no action, saying it did not find convincing evidence of a violation of the medical practice act. AP-NY-06-14-01 1942EDT Copyright 2001 The Associated Press. The information contained in the AP news report may not be published, broadcast, rewritten or otherwise distributed without the prior written authority of The Associated Press. All active hyperlinks have been inserted by AOL.
Response:
I can tell you what is starting to happen to rheumatologists at least here in Philly. One of the Medicaid managed care plans now requires prior authorization for Oxycontin and will only give Oxycontin without prior authorization for patients with cancer or sickle cell anemia. Other plans will only let you write a every 12 hour dose unless you are a pain management specialist. This I discovered on Thursday when a patient who I had nicely titrated on every 8 hour dosing because that it what worked for the patient found that the pharmacy would not fill my script. But apparently a pain doc can be more flexible with dosing than I can, as a rheumatologist. Meanwhile, you can buy whatever you want on the streets of Philadelphia but if you have RA or OA or spinal stenosis or osteoporotic compression fractures or fibromyalgia, you have to prove that your pain is equally worthy to the pain of cancer or sickle cell anemia. Do you ever wonder why so many rheumatologists, myself included, are thinking about retiring? DrSusan – Hide quoted text — Show quoted text – >There is a very disturbing article at USA Today regarding the DEA and the >OxyContin controversy. Steve brought this to my attention a few days ago. >Since I haven’t seen any discussion of it here, I’m going to post the URL. >http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to >be believed, the DEA has asked the manufacturer to impose restrictions so >that only "pain specialists and other doctors who regularly deal with >chronic pain" can write prescriptions for this drug. Doctors should be >deciding what medications their patients need, not Washington bureaucrats or >drug company executives. It’s one thing to keep crack and LSD off the >streets. It’s quite another to interfere with legitimate access to >prescription medications. This shortsighted policy protects would-be >illegal drug users from their own folly at the expense of people who need >these medications. >Becky
Response:
There was an article in this month’s "Spin" magazine about oxycontin as well. ALARMING what people are doing with this drug who don’t need it for pain. After reading this, I spoke to my rheumy and he indicated that the reaction that doctors are having and the actions they’re taking will prevent the red tape morons from getting too involved. However, Dr. Susan’s comments are a bit scary. I hope everybody’s voicing their opinions where it counts!! Susie
– Hide quoted text — Show quoted text -> There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
Response:
> Don’t most doctors regularly deal with chronic pain? (Got to > remember to say my prayers tonight and remember the thank you > for a Primary Care Physician who believes that inadequate > pain treatment is criminal) RISG Family wins suit against doctor accused of not properly treating pain <http://www.buffalonews.com/editorial/20010615/1003226.asp> … You’re a Redneck if you go to family reunions to look for dates. ___ Blue Wave/QWK v2.12
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Becky, Thanks for the info. There is a website called vote.com and this issue is actually addressed there. (I went looking for it after your informative email. By voting there an email will be sent to the head of the DEA.) The link is http://www.vote.com/vote/30739400/index.phtml I have already voted there and hope others will do the same. I wish just for one day the morons making these decisions could live with the pain we go through in a daily basis, the would think twice before making such idiotic suggestions. Donald – Hide quoted text — Show quoted text – > There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
Response:
Becky, Thanks for the info. There is a website called vote.com and this issue is actually addressed there. (I went looking for it after your informative email. By voting there an email will be sent to the head of the DEA.) The link is http://www.vote.com/vote/30739400/index.phtml I have already voted there and hope others will do the same. I wish just for one day the morons making these decisions could live with the pain we go through in a daily basis, they would think twice before making such idiotic suggestions. Donald – Hide quoted text — Show quoted text – > There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
Response:
Don’t most doctors regularly deal with chronic pain? (Got to remember to say my prayers tonight and remember the thank you for a Primary Care Physician who believes that inadequate pain treatment is criminal) — Jo Firey
– Hide quoted text — Show quoted text -> There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
Response:
Becky, there are several letter writing campaigns underway re: the oxy talk and so far its only talk. The chronic pain NG is very active in getting the word out. I will get a set of the addresses and post them for anyone interested in voicing their objections. I have voiced mine. johnie – Hide quoted text — Show quoted text – > There is a very disturbing article at USA Today regarding the DEA and the > OxyContin controversy. Steve brought this to my attention a few days ago. > Since I haven’t seen any discussion of it here, I’m going to post the URL. > http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to > be believed, the DEA has asked the manufacturer to impose restrictions so > that only "pain specialists and other doctors who regularly deal with > chronic pain" can write prescriptions for this drug. Doctors should be > deciding what medications their patients need, not Washington bureaucrats or > drug company executives. It’s one thing to keep crack and LSD off the > streets. It’s quite another to interfere with legitimate access to > prescription medications. This shortsighted policy protects would-be > illegal drug users from their own folly at the expense of people who need > these medications. > Becky
Response:
There is a very disturbing article at USA Today regarding the DEA and the OxyContin controversy. Steve brought this to my attention a few days ago. Since I haven’t seen any discussion of it here, I’m going to post the URL. http://www.usatoday.com/news/comment/2001-06-13-nceditf.htm If this is to be believed, the DEA has asked the manufacturer to impose restrictions so that only "pain specialists and other doctors who regularly deal with chronic pain" can write prescriptions for this drug. Doctors should be deciding what medications their patients need, not Washington bureaucrats or drug company executives. It’s one thing to keep crack and LSD off the streets. It’s quite another to interfere with legitimate access to prescription medications. This shortsighted policy protects would-be illegal drug users from their own folly at the expense of people who need these medications. Becky