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Pain, Drugs, Laws and Compassion

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On April 6, the Miami Herald printed a piece revealing that South Florida, Broward County in particular, has become the painkiller capital of the United States, a "notorious home to a cottage industry of storefront pain clinics selling alarming numbers of narcotics and feeding a brazen black market sprawling through the South and New England". At the same time, pundits (CNN's Jack Cafferty, HBO's Bill Maher and many others) clamor for legalization of street drugs, Secretary of State Hillary Clinton apologizes to Mexico for America's "insatiable demand for illegal drugs", and we increase our military presence in Afghanistan, whose entire economy rests on one crop, and guess what, it's not coffee.

I can't find a good, reliable number for what our failed, let's-call-it zillion-dollar interdiction policy has cost us. Perhaps that's because the number is a moving target, perhaps because the cost goes beyond mere economic dimensions. The high-profile issues include the cultural, social and physical devastation and destruction in South America and Southeast Asia, and of course our own violent streets. There's another drug war casualty that gets less play -- one that Herald article ignores -- namely the stigma attached to those who legally use narcotic analgesics: people in pain.

I went deeply into this problem in my 2004 book, The Truth About Chronic Pain. Pain patients may be suffering from chronic, progressive diseases -- often housewives trying to keep their lives and families together, blue (and white) collar workers trying to save their jobs -- or they may be our cousin suffering from a car accident, a parent (or child) with a terminal disease, our own degenerative intervertebral disc, or a grandmother whose end-of-life care is not the painless, peaceful decline they deserve, but an excruciating dance of humiliation, deception, prejudice, power-play and agony. Relatives often secretly suspect patients have done something to deserve the pain (a religious confusion), their doctors worry they may be addicts or become addicts (a misunderstanding of how pain medications work when pain is in the body and how ever-greater doses may be needed as the body "learns" to metabolize the medication) and neighbors may see them as weak, dishonest, or as junkies.

The truth is most pain patients are none of these things, but simply people trying to fight the ravages of disease, the consequences of injury and get through the day. They are no more addicts than are diabetics who require insulin or heart disease patients who take medications to normalize cardiac function. Of course there are junkies addicted to pain pills, just as there are junkies addicted to heroin, opium, cocaine and other illegal drugs, but they are rarely pain patients and there is nearly always a previous history of drug abuse or a strong genetic marker. The way legitimate pain patients are treated in our culture is an embarrassment, an outrage, and a disgrace.

Understanding the problem requires a broad context. The world is caught up in a web of drugs. Economies depend on them. Societies have grown up around them. Scores of big-time drug dealers, some of them among the world's richest men, rule communities and industries, but know better than to touch the stuff themselves. Drug abuse is a societal problem, a medical problem, and even a genetic/hereditary problem, but it is much, much more of a policy problem than it would be if we had the guts to face up to our own weaknesses and proclivities, as well as the problems of the inner city, the plight of disenfranchised youth, the private hell of alienated suburbanites, and of course the everyday Jane or Joe who never intended abuse but just got hooked.

There are an awful lot of these folks. Maybe they are all of us, to one degree or another. Nature's pharmacopoeia is a bounty, and we don't always engage or indulge or use it in proper medicinal fashion. We may choose alcohol, tobacco or coffee, or forsake natural highs for the poisons we design in labs or cook up in the crack house. The ravages of drug abuse and the junkie life are too deep, seen frequently in movies and on television (but not, it seems, frequently or honestly enough) and too often discussed to restate here. Human beings trapped by illegal drugs live lives bereft of everything a sane and healthy person would want, including health, dignity, social status, self-determination and self-control.

No pun intended, it is been high time to end the war on drugs and get serious about counseling, healthcare, rehab clinics, and education, and in the process relieve the stigma pain patients suffer. We are baring our breasts and letting our blood on Wall Street, on Main Street, in the White House, and on Capitol Hill. We are demanding more transparency and honesty from our leadership and legislators. It's a national frenzy right now, and I say it should include honesty with ourselves. Let's face up to the problems that lead people to want so keenly to escape their reality, to want so badly to reduce the pain of just being here, in America, in 2009, in the richest (perhaps until recently) and most technologically advanced (except maybe Japan) country in the world. Let's see what we can do to help people find meaning in something other than powders, plants and pills, and let's spend just a tiny fraction of what we've been spending on the drug war on education, intervention, public relations, a deluge of information that makes Noah's flood look like a dribble.

This is a contentious issue, mostly because people have judgments, prejudices and strong feelings about other people helping themselves and making their own choices. The great Chinese sage Lao Tze, whose work is my guiding light, reminds us that in the end our lives are all about maintaining balance and equilibrium, that we hold the keys to our own redemption, that the best we can do is to control ourselves, and that we can never control others. True enough. It may not be possible for every drug abuser to quit; indeed not every junkie may want a better life.

Yet in the face of free choice arguments, cries for capitalism, and the excuses of social Darwinism (yes, I've even heard the argument that "dying junkies are evolution at work") I'd like to suggest compassion. There are lots of folks out there who want to make a better choice but just need a little help. Let's give it, let's legalize, standardize and tax the heck out of illegal crops while we educate people about how to live without them. Let's reduce the murder and the torture, corruption, heartbreak, suicide, graft, injustice, drive-by shootings, incendiary neighborhoods, ruined national economies and soaring human agony, and oh yes, let's shake off our offensive judgments of people who want to live as free of pain as those of us who are lucky enough to be healthy.

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Please find all my books here and my latest novel here.

You can discover more about me at ArthurRosenfeld.com. Contact me at aero@aya.yale.edu.