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The American Inquisition: Chronic
Pain
Article 1
The American Inquisition: Chronic
Pain Introduction
By Dan Schweitzer
With review and input from a local physician who, due
to his present volume of patients, would prefer to remain anonymous.
Note: This is not intended to replace the expertise of
a physician, but to supplement and inform that expertise, as well as to
inform patients, potential patients, and those who live or interact with
chronic pain
patients.
In this first article, I would like to introduce you to the problem - some of the reasons that people in pain are not being treated properly in this country; sometimes they're not treated at all.
I call this series of articles The American Inquisition for several reasons.
In the religious Inquisitions, there was no way that people
who were being accused could answer any question or accusation that was
not interpreted as supporting the accusation. This is the same for chronic
pain patients, to whom I refer from now on as CPPs. Here
are a few examples:
Patient: "The drugs only take
the edge off the pain."
"Just give me something to take
the pain away. Do
something, anything!"
"I just want to stop hurting."
"Nothing else helps."
Despite test results that show a patient should be in
pain - though often the tests are never done - doctors can and do answer
all of these with, "That's exactly what an addict would say." It reminds
me of the
old question, "Have you stopped beating your wife yet
? Answer yes or no." Of course, there's nothing you can say that isn't
incriminating. It's exactly the same for a CPP. If he wants drugs,
he must be an
addict, so he gets none. If he doesn't emphasize that
only the narcotics bring any relief, he still gets none. It's always a
lose-lose situation.
Another reason for the title is that these are innocent
people who are suffering, through no fault of their own. The conservative,
often religious right has decided that these drugs are evil; that despite
evidence to the contrary, everyone who uses them for any length of time
becomes an addict, and that there is no difference between addiction and
physical dependence. They will insist on using the word "addict",
despite - or more likely because of - the connotations
that bring to the average listener's mind pictures of depraved street people
mugging little old ladies for the money for a fix.
Doctors who know how these drugs should be used, who use them appropriately and in accordance with guidelines laid down by several medical and legislative agencies, are still often hounded by the DEA and by uninformed, old guard medical boards. They are suspended without trial or any chance to defend themselves on the basis of pill count alone, completely disregarding the patients condition. Doctors, and sometimes nurses or even political appointees second guess these doctors diagnoses and treatments, even though they've never seen the patient. Law enforcement agencies "sting" doctors by sending in agents to pose as people in pain. When these doctors prescribe something to help temporarily while they decide on tests to be run or specialists to refer the "patient" to, they end up losing their practice and maybe going to jail. Even if they are finally able to prove that they acted in good faith, even if it's finally accepted that they prescribed appropriately, they are still required to spend huge amounts of money trying to regain their suspended licenses, to attend required CME classes, to defend themselves in court and so on. Their reputations are permanently ruined. They lose time and patients, therefore income, in their practices; they often see their names in local newspapers, being referred to as "Dr. Feelgoods". There's nothing they can do about it. Their patients, those who don't commit suicide after having their lives pulled out from under them again, are often sent to drug rehab, or more often, they're simply dropped and allowed to go through dangerous and painful withdrawal, and are then ignored, and left in pain again. Pain that never stops, never goes away, can also be called torture.
In other words, the accused addicts are used as weapons against anyone who tries to help them, and to be accused is to be guilty in the eyes of the accusers and the public. Would-be defenders are reported as, "…coming out for drugs". No one dares try very hard to defend the accused lest they also become stained by association and maybe accused themselves. Any evidence that can't be turned against them is ignored. Innocence, good faith, compassion, legality, medical need and correctness - none of it matters; only the accusation does.
What really makes me angry - well, one of the many things about this that makes me angry - is that a great many political advocates of this type of treatment, or lack of it, are in it simply for the sake of a safe political platform. They're being "tough on drugs". Let their opponents argue, and the dissenters are instantly painted with the brush, "pro-drug." It doesn't seem to matter that the only people really being hurt by the "War On Drugs" are doctors, and patients who desperately need treatment.
This all sounds like the old Inquisitions to me; hence the title, The American Inquisition.
Here are some realities:
1) Every independent study ever done (meaning studies by people and agencies with no axe to grind), in this country or elsewhere - has concluded that criminalization of drugs creates and maintains a super-wealthy criminal class; this class - or it's money - often has access to legislators and politicians. It makes treatment for real addicts all but impossible, as the choice they're left with is to allow the drug to ruin their lives, or allow the law to do so. It also makes these drugs all but unavailable to patients who need them - who often need them to live. It raises street prices of otherwise inexpensive substances to unbelievable heights, and raises prescription prices to levels where even the patients who can get prescriptions often can't afford to fill them.
2) It fills our jails with people "guilty" of "victimless
crimes", which should be an oxymoron. Eighty percent of the people in prison
(per the FBI, 1998) are in for drug-related charges, most often simple
possession.
3) We have the highest percentage of our country's population in prison in the world, the majority of whom were and would be law abiding, productive citizens.
4) Criminalization keeps literally billions of dollars flowing into law enforcement coffers, and many others every year. Even though drugs are more available on the street now than they ever were, even though this trend continues and accelerates as we throw more and more money at the problem, we keep using the same old tactics that have shown themselves to be completely ineffective at attaining the stated goal. None of these agencies wants to lose that funding, of course. Nor do those who may get contracts to build and maintain prisons. More lives are ruined by the response of the law to drugs than are ever ruined by the drugs themselves.
5) Prisons are terribly overcrowded now, and our priorities are so skewed by this anti-drug propaganda that violent criminals are released and drug users are kept when there isn't room for both. Let's translate this into a statement: "all right, the violent criminal might go out and beat or even kill or rape someone, but the druggie might go out and get stoned! Keep the druggie; turn the other guy loose!" This actually makes sense to some people.
Understand that I'm not equating "recreational drug use" to prescription drugs being used by people who need them for their intended medical purpose. Sadly however, they are linked - by the law, by regulatory agencies, and in peoples minds. This is why I'm addressing both of these issues here.
Law enforcement agencies are painfully aware that, for anyone who cares to look, they aren't doing their jobs. The more money they get, the more ineffective they seem to be. (Please keep in mind that most police are decent, hard working people; it's not their fault they've been given a job to do that can't be done this way). The effect of this is that, since they can't control criminal drug businesses, they often go after legitimate businesses: doctors, pharmacists and patients. Such people aren't trying to hide what they're doing, so they're easy targets, and the law can be seen to be doing something, at least. Demonize the drugs, and you demonize anyone involved with them, whether their involvement is legal or not. Sound cold bloodedly calculated? It is.
I've heard many political types say that if we legalize drugs, they will suddenly become easily available to our children. This means that these politicians think that drugs aren't available to our children now, which (I hope) we all know to be a fallacy. Also, evoking danger to our children is a wonderful way to get a visceral, knee-jerk reaction and throw logic out the window. Let's look at what happened with prohibition.
Alcohol was made legal again for several reasons. One
of the main reasons was that the majority of people were ignoring the law.
Another was that criminals and criminal organizations were getting rich
because of this law, and were making acquisition and consumption of alcohol
very dangerous for ordinary citizens. There was no way the government could
protect these citizens against impurities in the product; people were often
poisoned. The law finally figured out that people had been using alcohol
for the better part of probably twenty thousand years; they weren't about
to stop now just because some people thought it was
immoral. After legalizing and regulating (and taxing)
alcohol, the huge expenditure for trying to enforce the unenforceable became
a huge source of income. People stopped being shot and blackmailed by illegal
alcohol dealers, and stopped being poisoned by impure alcohol. So what's
different about these drugs that are the targets of the Drug War? In a
word: nothing.
Patients who have bought into the anti-drug propaganda even refuse the drugs because they're afraid of becoming addicted, so cancer patients die in agony and fear. Chronic pain patients lose everything - homes, jobs, families, dignity, sanity. Finally, as many as 16,000 of them take their own lives every year; they die in agony and despair.
Studies have shown that people who take narcotics for pain gain back their lives. Some even manage to go to work again. They can rest again, think again - live again. They don't get "loaded" or "buzzed". It seems that the drug and the pain cancel each other out, for which there is now a proven physiological reason. Significantly less than one percent of patients treated with narcotics over the long term end up with an addiction problem. In that particular study, it turned out that a couple of these people had had problems with drugs before the study was done. Lastly, even addicts can be in pain. Do they deserve treatment less than other people? Even an addict's pain can be treated, with proper precautions to prevent misuse of the drugs.
More and more research is turning out to show that, far
from being the terrible danger that they're being made out, narcotics are
a useful, sometimes life-saving tool of medicine. A hammer is a tool; so
is a gun. They can be used to build a home, or to feed or protect those
you love. They can also be used to bash someone's head in or to kill someone
while robbing a liquor store. This hasn't caused us to make them entirely
illegal, though. They are regulated and taxed, and while there will always
be those who will misuse them, for the most part they are very useful tools.
Isn't it past time we applied some logic and
compassion to this problem?
by Dan Schweitzer
February,
2000
