Increasing Agony, Not Fighting Addiction

This week, the New York Times has begun an important series, examining the horrific lack of access to pain medication faced by the vast majority of dying people in the world. Although morphine is one of the cheapest medications there is -- and God knows there's no shortage of opium poppies in Afghanistan or elsewhere -- cruel laws and devastating myths about these drugs prevent people in agony from having access to them.

Think about it: we have the ability to ease the pain of the dying, even when we can't treat their illnesses or injuries, for pennies a day. But we don't do so -- in fact, we directly prohibit them from getting these medicines -- because we are afraid that either we will addict the dying or that addicts will somehow get access to this medicine somewhere along the supply line.

What kind of insanity is this? If you are dying, what does it matter if you are physically dependent on a drug? What does it matter, even, if you develop a compulsive desire for more of it? And why should people who live with painful conditions that will not kill them suffer, either, for that matter? We are so misguided in our thinking about addiction that we prefer people to live and die in unspeakable agony rather than risk them having a bit of extra euphoria!

We have so mythologized the effects of these chemicals that we believe they will make the dying rise from their beds to stalk others in search of an angry fix, killing, raping and maiming along the way. The Times printed a quote from the founder of a Ugandan hospice who said, "We are coming out of a war where a lot of human rights violations were caused by drug abuse."

But there's far more evidence to link drug prohibition with human rights abuses than there is to link them with the pharmacology of drugs, particularly opioids which tend to calm users, not excite them. For example, countries like Iran and China execute people accused of drug use and dealing -- without many due process protections. Here at home, we have innocent people killed by drug-fighting SWAT teams, racially-biased prosecutions, incarceration and denial of the vote -- and forfeiture of property without due process. We have invasive drug-testing in high schools, serious problems with informant-based testimony, and countless other examples of what has been called "the drug war exception to the Bill of Rights."

Further, research on drugs and violence finds that the vast majority of "drug-related" violence is linked not with the way the drugs affect the brain, but with the way completely unregulated free trade in high-demand goods affects markets. Research on the crack trade in the 80's found that more than 80% of this violence was due to disputes between dealers over "turf" and other market-related issues. We used to see the same kind of "drug related violence" in the alcohol trade under Prohibition.

We're not going to see cancer patients turned into crazed criminals if given morphine. And if the worry is that illicit users will get drugs intended for patients, well, why should the patients suffer to prevent the crimes of others? The drug war sure hasn't kept drugs out of the hands of addicts -- there's no reason to think keeping morphine out of cancer and AIDS wards in the 3rd world is going to do so.

The answers to addiction lie not in preventing pain patients from getting relief, but in keeping addicts from needing escape. That may well be an impossible goal -- but working to reduce desire to flee reality by doing things like reducing economic inequality and treating other mental illnesses like depression that often drive addiction at least do not have the dreadful side effect of increasing the agony of others.

Comments

[mlang52]

Mis-information, is still the backbone of the "drug war" personnel. Addiction is actually very rare in chronic pain patients, Yet, that is what 90% of the doctors in this country are lead to believe! They are not asked to change their attitudes (that have no scientific basis, at all). Stay ignorant and throw the 10% "wrong" into jail or out of practice. Ignore the 97% of the pain patients that are not addicted! Another point, any good pain doctor knows there is not a "maximum LEGAL dose" of any opiod drug!
Dependency does not equal addiction. Yet, that is exactly show up in the other letters. There is not a common knowledge that the situations are very different. People treated for chronic pain rarely would get a "buzz"! They may be dependent, but, in no way, addicted.
And, fentanyl, although very good, is much more expensive! But, the cost means nothing to most doctors. They think more expensive is better. I think $1.00 of morphine for a week would treat a patient better than $1.00 of fentanyl! And that is one of the reasons that the fentanyl is not "just as available". (The article is referring to third world countries.) And, when comparing the cost effectiveness of the medication, one must admit that non-synthetic opiates could be the least expensive. And they would be just as potent , whengiven in adequate, proper doses. Double the dose of medication needed to control the pain and the cost of the fentanyl looks like it goes up, exponentially, in comparison! And Heroin is not the true, drug, name. It is acetylmorphine. Look familiar?

And even though many of us have been accused of being to casual with our prescriptions, I guess tho person to ask would be the one that cannot get his pain treated any more because of the insane attitude against treating chronic pain patients, properly and cheaply, with opiods!
The drug war is now a war against pain patients. They, sometimes, take their own lives rather than suffer such agonizing, constant, untreated, pain!

[LeoMarvin]

I believe you're responding to my comment. Whether the fault is yours or mine, you apparently misunderstood much of what I said. But that's OK. It's neither necessary nor worth the time it would take to correct the misunderstandings since, and this may come as a surprise to you, we're making the same argument.

[Aramingo]

If someone is terminally ill, I think you're in WTF territory when it comes to pain relief. Until one of those types who get their knickers in a bunch about drug abuse can produce documentation that corpses go through the agonies of withdrawl, I'll stick to my point.

I've seen cancer kill, up close and personal. I would have done what ever the victims asked to ease their suffering.

[cynara]

I was in the hospital once, in a tremendous amount of pain. I had gone into shock because of the pain and as I regained my senses the doctor asked me if I wanted morphine. I was scared to death to say "yes" given everything I'd heard about it. But I didn't really have a choice, so I took it.

An hour later, they asked how I was feeling. The pain had dulled, a little bit, though it was still horrendous, and I was suprised that I wasn't tripping in the least bit due to the morphine. I asked the doctor why I hadn't even begun to feel the morphines affect. His answer - morphine targets pain first, after the patient is no longer feeling pain, then it gets you high. That said, they had already given me the highest possible legal dose of morphine, so if I was still in pain, I'd just have to grin and bare it.

If someone really is terminally ill, and in unending pain, I doubt the morphine would make them high either. Obviously, they'd want more of it, who doesn't want to make the pain go away? But I doubt that they would get addicted to the phsycal high of morphine, if the morphine is treating the pain first, they wouldn't even feel the high, like it did in my case.

Some doctor who has more experience in pain midication than me, feel free to confirm or deny this.

[LeoMarvin]

I'm not a doctor, but I have enough anecdotal familiarity to tell you that it's not really the high one gets addicted to. The high is just one of several lures that get people using frequently enough to establish the physical dependency. For some addictive personalities, the lure is the high. For self-medicating depressives, it's relief from the depression. For pain sufferers, it's relief from pain. But ultimately, once the dependency is established, what drives the addiction is not the initial lure, but a craving to stop and reverse the progressive torment of withdrawal. This is the Faustian payoff, where many addicts can"t even take enough to get high any more, but they keep using anyway to postpone the inevitable withdrawal.

Addiction is a horrible thing. It destroys many, too many lives, and those it destroys often in turn leave havoc in their wake. And the truth is that some level of physical dependency is probably inevitable for almost anyone treated long enough with morphine strength drugs, so it shouldn"t be casually encouraged. But for patients with extremely painful conditions, especially terminal ones, addiction is the lesser evil. It can usually be managed with patients under full time care and many who aren"t. In no event is such addiction a reflection on the patient"s character (if any addiction is). To withhold adequate pain relief from such people is just an unpardonable exercise in tails wagging dogs.

[karen4U]

Your "right on" comments are just the tip of the drug insanity iceberg. We're so used to euphoria being outlawed that we live year after year watching tens of thousands of people being incarcerated for drug related offenses, and then, afraid, depressed and anxious, they are in violence boot camp. Throw in private prisons that make more profit when there are more prisoners and you have one part of the picture. Then you have the billions if not trillions of dollars that are paid out by patients and insurance companies to pharmaceutical companies for mood alteration....legal if someone holds a patent. Everything about the way this culture relates to drugs, both legal and illegal is part of our collective mental illness.

[andygaus]

We don't have to wonder what Jesus would say about those who deny relief and healing to the sick on legal grounds. In Luke 13 and Mark 3 you read how Jesus responds to the priests who charge him with performing "illegal" healings. He is described as being almost beside himself with anger.

[dadw5boys]

Well we know that Poppys will grow anywhere in the world and mankind can harvest a natural pain relivers from them.
Would Jesus say go forth and pick the poppys of the feild to relive your pain or say the drug companies had a right to make people destory all the poppys that grew wild in the feilds.

[Dunnage]

If I am correct, medical(pure)heroin is even better for agonizing pain than morphine. It is used in Europe.

[LeoMarvin]

Given the cultural resistance in this country to heroin, there are other very effective, less controversial alternatives to morphine when something stronger is needed. For example, fentanyl is about 80 times stronger than morphine and just as available. Heroin's high solubility makes it very useful, but nobody need suffer in pain as a result of its categorical prohibition.

On the other hand, pot is for many people uniquely and irreplaceably effective. I have a brother on chemo, and smoking pot is the only relief he's found from its debilitating side effects, which otherwise prevent him from eating, sleeping or for the most part functioning at all.

Like the intimidation of doctors who prescribe adequate pain relief, our moralistic, knee-jerk pot prohibition is senseless and cruel. It's a sad irony when, from time to time, religious conservatives stricken with cancer discover the medical virtues of pot as a last resort. Of course to the authoritarians they left behind, it's their character that comes into question, not the justification for superstitious criminalization of useful medicine.

[oldpotsmuggler]

A DRUG WAR STORY - #9

Owsley was clearly one of the first celebrities of the underground culture that developed in the sixties. Pretty much all of the acid we dropped back then was said to have been made by him, and, as it turns out, often it was. What a beautiful thing to have such a good reputation that your name could be a selling point for a psychedelic drug.

Our drug warriors are so rabid that Owsley was literally arrested for making LSD before it was even illegal to do that. Needless to say, he beat that charge.

Ultimately, however, the legislative void was filled, and Mr. Owsley received his due at the bar of justice. And not a second too soon, I"m sure. Can you imagine where our country would be today if many of the people in the upper reaches of power grew up in an environment where recreational drug use was accepted, and almost even expected?

Oh, that"s right. That"s the world we live in now, isn"t it. And the leading edge of "The Greatest Generation" grew up flouting the law during the era of alcohol prohibition.

I guess it just goes to show that you never can tell.