The American Inquisition: Chronic
By Dan Schweitzer
With review and input from Dr. Stevens of Bend, OR.
Note: This column 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.
"We must all die. But that I can save a person from days of torture is what I feel is my great and every-new privilege. Pain is a more terrible lord of mankind than even death itself." Dr. Albert Schweitzer, 1953.
Doctors are in a very difficult position right now regarding pain treatment. Recently in Oregon, a doctor was reprimanded by the Medical Board, and was required to attend continuing education for "prescribing inadequate pain medication" for a terminal patient. He gave the man aspirin for his cancer pain, and the man died in agony. There is more and more agitation, however, for legal punishment of doctors who under treat.
On the other side of the coin, another doctor was "stung" by DEA agents posing as pain patients. The doctor prescribed narcotics in good faith, and received a very stiff sentence. Things like this have been going on for years. What pain patients call "compassionate physicians" have lost their licenses, been arrested, and have been financially destroyed by the DEA and by local medical boards that are chaired by "old guard" doctors who still believe that that opiates are "evil". This has happened despite new guidelines adopted by the Federation of State Medical Boards of the U.S. for the treatment of pain, and despite intractable pain laws that many states have adopted. In essence, the "War on Drugs" has become a war on doctors and suffering patients.
My own (and others) interpretation is: Every independent study ever done of the drug war has concluded that illegalization and stiff penalties have actually created and maintained a criminal class that meets the demand for "recreational"drugs. For decades, billions of dollars have been poured into the effort to stop the drug trade by criminalization. The result has been an increase in drug traffic, an increase in drug street prices and in drug related violence, and an increase in people incarcerated for drug related offenses (usually simple possession) to the tune of 80% of our prison population (per the FBI). One other effect has been that billions of dollars have been poured into the DEA and other law enforcement agencies, and no one wants to lose that kind of funding.
Our Puritan heritage has left this country uniquely vulnerable
to religious influence; we are distrustful and controlling of pleasure.
For all its destructiveness, recreational drug use, including alcohol and
tobacco, is pleasurable, at least in the beginning. A great many of us
are still prohibitionists at heart, and though we learned from prohibition
that criminalization doesn't work, we still fund it, we still use it successfully
as a campaign platform, and it still brings in votes and big funding. This
attitude has been used with phrases
guaranteed to cause knee-jerk reactions like, "Drugs are destroying our children", or "Just say no" (as if it were that simple). People trying to pass reasonable measures based on science instead of hysteria are slammed politically as "coming out for drugs", which of course sounds terrible.
Unable to interdict a border many thousands of miles long, unable to stop domestic growers and manufacturers, law enforcement has to be seen to be doing something for all this money, so the next logical target is prescription drugs, the patients who need them, and the doctors who prescribe them. Desperate patients in pain are called addicts; doctors who try to treat them are "Dr. Feelgoods". The money keeps rolling in for enforcement and new prisons, and people keep suffering.
These two dangers, plus the sad facts of inadequate education of medical students in pain management, and belief in the drug war propaganda makes many doctors very reluctant to prescribe adequate amounts of pain medication even for acute conditions. (Again, an acute condition is something like a broken bone or an operation, after which the pain can reasonably be expected to go away) Something on the order of 60% of children are given nothing for pain even after an operation like open heart surgery.
The new treatment paradigm, backed up by research, calls for treatment of pain. All necessary tests must be done, all possible treatments that may help should be tried, but for those who are left after all of this without relief are entitled to the only treatment remaining: medication to ease their pain.
Many patients will not take narcotics because, even though they may be terminal, they don't want to become addicts. Everyone knows that addicts mug little old ladies for the money for a fix, right? Despite studies that show that significantly less than one percent of people whose pain is treated with opiates have a problem with addiction, doctors and patients alike are still sure that people who take these medications for very long will become addicts.
Another myth is that the patient will become "fogged out"; they'll have memory problems, spend most of their time asleep, have hallucinations and so on. People in end-stage cancer and other diseases do indeed have some of these problems, but for most, the problems are caused by kidney failure and uremic poisoning, liver failure and so on. The last couple of days or hours can see serious side effects of large doses of narcotics, yes, but isn't this a bit better than dying in screaming agony? I certainly think so, and I believe that people should have a choice.
For those of you who still don't understand, pain is a life destroyer. It takes over a person's life, it destroys relationships, it removes the ability to work, to rest, to contribute. It all too often removes the desire to live. The last people who should control access to medical treatment for anything, especially pain, are political opportunists.
The next article will talk about resources that are available
for chronic pain patients. After I've presented the basic issues and information,
I will encourage questions, for which I will print here an address in the