So, they've finally arrested Rush Limbaugh on prescription drug charges. Part of me wants to say, "It's about time."
But the other part of me, the part that knows about the horrific under-treatment of pain in this country and the insanity of the "war on (some) drugs," says no matter how much someone richly deserves a come-uppance for hypocrisy, we all suffer from such enforcement. (Of course, people like Rush suffer far less because their privilege allows them to avoid prison--but that's a story for another day).
What did Limbaugh do, exactly? He tried to relieve his pain--and when one doctor wouldn't give him enough medication, he apparently sought others. Does it really matter that at some point, Limbaugh may have stopped trying to assuage merely physical pain and started blunting emotional pain? Who was helped by simply stopping all of his prescriptions?
Some might argue that doing that prompted his "recovery" and might have saved his life. But others have seen their friends and relatives in the same situation, cut off, suffering and yes, still using. But now using street drugs of unknown purity and provenance--and now with no contact with medical professionals that at least could have been an opportunity to reduce harm and encourage treatment. And continuing to use, even after they get sent to jail. Whether they were addicts, addicts who also had pain problems or pain patients misperceived as addicts, taking them out of the medical system only adds costs and does little to deal with the real problem.
When people become drug addicts, the problem isn't the drugs. The problem isn't the doctors who prescribe for addicts, knowingly or unknowingly. The problem isn't the dealers. The problem is pain and ways of coping with it, whether it be the pain of life or bodily pain. And why it should be OK for us to treat emotional pain with some drugs--say, Prozac or even alcohol--but not others is simply an expression of prejudice.
Opioids are powerful substances, but no drug can make someone into an addict. That involves choices--because by definition, addiction is compulsive use of a substance despite negative consequences. If I were to take you hostage and inject you with heroin every day for a month, you would feel a flu-like set of withdrawal symptoms, coupled with some anxiety and insomnia for about four days if I suddenly stopped.
But you wouldn't be an addict. In fact, if you are like some 90% of the people tested by researchers funded by the National Institute on Drug Abuse, you probably wouldn't actually like the experience of being on strong opioid drugs--you would find it nauseating and numbing and would feel an unwelcome distance between yourself and the world.
Only if you were amongst the minority would you find it euphoric and welcoming and worth giving up the rest of your life to chase on a daily basis. And if you were in that group, chances are by the time you'd hit your mid-20's, you would have already found relief through psychoactive substances of one kind or another and your brush with me would not have been your first experience of addiction.
Because the research is pretty clear that it is an extremely rare person (though it does sometimes happen) who is destined to suffer a period of addiction in his lifetime who hasn't discovered this unpleasant propensity by early adulthood.
So, in Rush's case, the exposure to opioids he had for pain treatment was probably not his first period of addiction. If it was, are we even sure that he was getting high and not just seeking extra meds because what he was given by his docs wasn't touching his pain?
After all, Rush is not a small man, and in the current climate, doctors are afraid to prescribe high doses of opioids for long periods of time due to increased scrutiny by the DEA. Few docs are willing to prescribe opioids at all for chronic pain (like Rush's back pain) that isn't likely to be immediately fatal because dozens have been prosecuted in recent years after addicts scammed them and resold medication.
There is a phenomenon called "pseudo-addiction," in fact, where pain patients seek escalating doses of medication and appear compulsive about it--not because they want to get high, but because they are in excruciating pain and are not receiving adequate relief.
Once relief is obtained, however, such patients no longer seek extra medication and become functional. Is this what happened to Rush, quietly, behind the scenes, once he'd made his public expiation by attending rehab? We'll probably never know.
But right now, millions of pain patients are not receiving adequate treatment because their doctors are afraid to prescribe for them. The emails I read on a list discussing chronic pain are a painful experience just to look at--stories of veterans with catastrophic injuries being left without relief due to doctors' fears of arrest, stories of people having their dose cut arbitrarily even though they are doing well, stories of people whose doctor was arrested not being able to find someone else to prescribe and being left in withdrawal and in agony.
The great Oxycontin crackdown--just like the great cold-medicine lock-up and the great cocaine crackdown of the 80's and previous efforts to stop addiction by cutting off supplies--hasn't made a dent in the problem. All these efforts do, occasionally, is make some people switch drugs or suppliers.
So am I happy Rush is getting a slap on the wrist? No, what I'd really like to see him do is expose the insanity of attempting to fight drugs by putting doctors in jail, locking up addicts and keeping necessary medicine away from patients who need it.
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