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.
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