Posted on 03/05/2004 9:11:29 PM PST by neverdem
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| Jacob Sullum's Syndicated Column Gotta Hurt (3/5) |
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March 5, 2004
Gotta Hurt
The irreconcilable conflict between drug control and pain control
As part of its recently unveiled "strategy to confront the illegal diversion and abuse of prescription drugs," the federal government promises to close down pharmacies that sell narcotic painkillers online. After all, only druggies need to purchase Vicodin through the online "pill mills" that "bypass traditional regulations," selling to anyone who fills out a questionnaire. People with a legitimate medical need for such drugs can always get prescriptions from their doctors.
Don't you believe it. Swayed by anti-drug propaganda and anxious to avoid legal trouble, physicians are so leery of these drugs that researchers have given their attitude a name: "opiophobia," an unreasonable fear of narcotics that leads to untold suffering by millions of Americans. Opiophobia intensifies every time the government announces a crackdown like this one.
I have a friend (let's call her Marcy) who periodically suffers from severe neck and shoulder pain, sometimes accompanied by splitting headaches that can last for days. During one of these bouts, she tried Vicodin (a combination of the opioid hydrocodone and acetaminophen), which she had left over from a prescription she received after knee surgery. It worked much better than the ibuprofen she usually took, cutting short the headaches and making the neck and shoulder pain bearable.
After she used up the Vicodin, Marcy discovered that her doctor was unwilling to prescribe more, even as she warned Marcy that continuing to take large doses of ibuprofen could damage her liver. The doctor suggested muscle relaxants, physical therapy, acupuncture—anything but the medicine that Marcy knew would work. The doctor explained that such drugs "can be habit-forming."
In Marcy's case, this concern was ridiculous. She did not even like the psychoactive effects of hydrocodone; she took the pills only when she was in serious physical pain—not every day, not every week, not even every month. A bottle of 90 would last her more than a year.
Yet Marcy's doctor was implicitly telling her it was better for her to suffer (or continue using a less effective, more dangerous medicine) than to take the essentially nonexistent chance that she would become a Vicodin junkie. That's how Marcy became a customer of one of those online pharmacies the government wants to put out of business. She continues to use the pills only when necessary and has never been tempted to do otherwise.
Contrary to what the government would have you believe, Marcy is not unusual in this respect. Research consistently has found that patients who use narcotics for pain rarely become addicted to them, and those who do typically had pre-existing drug problems.
It is simply not true, as Rush Limbaugh implied when he blamed his pill habit on "highly addictive medication," that opioids have an irresistible power to enslave people. They are only as powerful as people's reasons for using them.
The government demands that doctors figure out what those reasons are, threatening them with loss of their licenses and criminal prosecution if they fail to do so accurately. But doctors are not mind readers, and pain cannot be objectively verified. Faced with a choice of trusting their patients or protecting their livelihoods, they often will choose to play it safe, as Marcy's doctor did.
And Marcy is relatively lucky. For patients who suffer not from occasional bouts of pain but from constant agony that can be kept at bay only with large doses of opioids, getting relief is both more important and more difficult. Desperately searching for someone who is willing to treat them over the long term, they begin to look more and more like "doctor shoppers," the malingering addicts the government tells physicians to avoid.
By raising the volume of such warnings and encouraging the proliferation of prescription monitoring programs that look over doctors' shoulders as they decide whether to believe their patients, the government inevitably will compound the already scandalous problem of undertreated pain. In response to such concerns, federal officials assure us that nonmedical use can be prevented even while making sure that pain is adequately treated. But these two goals are fundamentally irreconcilable, because doctors will never be omniscient gatekeepers.
The Office of National Drug Policy says "more than 10 million Americans suffer from chronic pain." According to the American Pain Foundation, the number is more like 50 million. That disparity, which suggests the extent to which drug warriors underplay the need for narcotics, gives you a sense of the gap between the government's assurances and the painful reality.
Jacob Sullum is a senior editor at Reason and the author of Saying Yes: In Defense of Drug Use (Tarcher/Putnam). © Copyright 2004 by Creators Syndicate Inc.
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This crazy war on drugs causes more organized crime, screws up what were recognized constitutional rights, caused the death of more than a few innocent folks with no-knock entries on incorrect addresses, became a full employment act for LEOs and screws up medicine as well.
I see an ADA class-action lawsuit in the mix.
I blame the Doctors, who will not be bothered with politics, from fear and the complance of having had a sucessful "Progressive Education."
Uh...yeah. OK. I am just speaking to the proven medical effectiveness of opiates in pain management. The WOD is a seperate topic. But in some ways they are related.
They've done some studies showing marijuana is effective for some types of pain, but the gov't is very reluctant to fund such studies.
People have to pay doctors to get basic pain relief.
I hope she was getting a more potent and longer acting opiate like Fentanyl patches or MS Contin. I refer you to my comments about docs getting sued successfully. Pain control is now a standard of care.
People usually have to pay docs to get treated. Taking opiates can be tricky with many adverse effects including possibly lethal from respiratory depression, or a wicked constipation to the point the patient has to be hospitalized and manually disimpacted.
Please read comment# 4. How's it different from the roaring success that was known as alcohol prohibition and all the problems that caused? Moderate alcohol consumption appears to have beneficial cardiovascular effects. The only other medical use ethanol, i.e. drinking alcohol, has that I know of is as an antidote to methanol and ethylene glycol poisoning, i.e. wood alcohol and antifreeze, respectively, which is caused by current restrictions on ethanol.
I'm not advocating any kind of drug abuse, but marijuana and opium have been used as medicine for millenia. Cocaine solutions are used as topical anesthetics. The morbidity and mortality from illegal drugs pale in comparison to ethanol. I regret to inform you that you're not going to change human nature by police state measures. Those druggies are going to get their drugs by hook or by crook. Do you think that there would be so murders and so many assaults on the Second and Forth Amendments if there wasn't so much money to be made in illegal drugs?
I have a few libertarian sympathies. How did you guess, did you read my profile page? I also happen to like the original U.S. Constitution and quite a few friends who are LEOs including my best friend. What's a guy to do? I guess I'll just have to suffer the insults in quiet resignation. Father forgive them, they know not what they do.
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