At last week’s End It For Good Community Discussion in Natchez, MS, an attendee mentioned how cracking down on opioid prescribing led to many doctors being unable to adequately treat their patients.

This week a fascinating new white paper came out from CATO Institute on that very thing.

It’s called “Cops Practicing Medicine: The Parallel Histories of Drug War I and Drug War II.” The authors, Dr. Jeffrey Singer and Trevor Burrus, weave storytelling and research together to show how US policy on opioids has backfired. For 100 years.

At the heart of the disaster is the shift we made in the early 1900s to expand the role of law enforcement and diminish the role of medical professionals where opioids are concerned.

I remember a couple of years ago when it struck me that although doctors go to medical school for years before they can treat a patient with opioids, law enforcement agencies without medical training can arrest doctors or patients when they believe opioids are being inappropriately prescribed or used.

I have huge respect for doctors and police officers, but it seems like doctors should be the higher authority in matters affecting your health. We wouldn’t ask a school teacher to manage a building renovation or a pharmacist to design a bridge. Expertise matters in many areas, especially in something as important as healthcare and pain management.

The paper makes 4 recommendations, and I’d love to hear your thoughts on them.

1. States should resist efforts to codify any new guidelines released by state and federal public health agencies. (Background: The CDC released opioid prescribing guidelines that states turned into laws. When these guidelines changed after collateral damage like this became clear, most state laws weren’t updated. Laws are very inflexible.)

2. The DEA should no longer be empowered to impose manufacturing quotas on opioids. (Background: Every year, the DEA determines how many opioids they believe all 330 million Americans will need in the coming year. Manufacturers can’t exceed these quotas, leaving many people without adequate pain relief – unless they buy illicit drugs – when quotas are too low.)

3. Federal and state law enforcement should be required to get a warrant before perusing a state’s prescription drug monitoring program database. (Background: In many states, law enforcement can look through the prescription drug monitoring program database, accessing your prescription history at will – even when no criminal activity is suspected.)

4. All physician prescribing behavior considered suspicious by law enforcement should first be reviewed by state medical licensing boards before any action is taken against the prescriber. (Background: We already trust medical boards to hold medical providers accountable in a range of areas. They – not law enforcement – have the medical expertise to determine if a doctor is prescribing in a way that should trigger a referral for a criminal investigation.)

If we want to see better outcomes related to opioids, the sooner we understand opioid use as a health issue, the better. The criminal justice system’s outsized role in people’s medicinal or recreational opioid use led to disastrous outcomes in the first half of the 20th century, as outlined in the paper, and it’s doing the same thing today.

What do you think? Can we roll back the criminal justice system’s overreach into healthcare and find a middle path where doctors are accountable, pain patients are adequately treated, and addiction is helpfully addressed? Hit reply and share your thoughts; they come directly to me.