The war on pain relief

October 13, 2003 11:50 AM

The war on drugs is unfairly targeting doctors who prescribe legal pain medication to their patients who suffer from chronic pain, according to a spokeswoman of the Association of American Physicians and Surgeons. She was speaking at a press conference of patient and physician advocacy groups, sponsored by the Pain Relief Network, in support of Dr. William Hurwitz. Dr. Hurwitz has been indicted and imprisoned for prescribing high doses of opioid pain relievers, as have other pain-management doctors. But these crackdowns may end up doing more harm than good to patients in chronic pain. [More inside.]
posted by homunculus (22 comments total)

Here's a short article Hurwitz wrote on pain medicine regulation: Pain Control in the Police State of Medicine (PDF).

Here's Geov Parrish's piece that's mentioned in the Reason article on his experience using OxyContin.

The Reason article also has the full Taliban quote that's refered to in the first link:

"The growing national plague of Oxy addictions, overdoses, and deaths caused by the illegal activity of some doctors, pharmacists, and patients has been focused on like a laser beam by this office and other U.S. attorneys’ offices," Gene Rossi, a federal prosecutor in Alexandria, Virginia, told The Washington Post in August. "If any person falls into one of those three categories, our office will try our best to root that person out like the Taliban. Stay tuned."

My view is that there are certainly some doctors who are inept and some who are corrupt, and maybe Hurwitz is one of them. But comments like this and calling Hurwitz a "street-corner crack dealer" lead me to believe that this is the opening of a new front in the drug crusade. I fear that some innocent physicians may be prosecuted and many patients suffering chronic pain will be unable to get help.

[Some links via Drug WarRant and TalkLeft.]
posted by homunculus at 11:53 AM on October 13, 2003

Meanwhile, the battle over medical marijuana continues in Oregon, while in California, outgoing governor Davis signed bill SB420 last night, which will create ID cards for medical marijuana users to show to law enforcement officers.
posted by homunculus at 11:56 AM on October 13, 2003

Tell it to Rush Limbaugh.
posted by alms at 12:09 PM on October 13, 2003

Strange how the GOP is so big into "states' rights" but they love to bust Oregon for both the doctor-assisted suicide and marijuana laws.
posted by mathowie at 12:16 PM on October 13, 2003

Meanwhile one in five Europeans suffer from "chronic pain."

That's a lot of potential terrorists out there.

Oh yeah, oblig' link on War on Drugs, written by an ex-DEA officer.
posted by Blue Stone at 12:19 PM on October 13, 2003

Some more resources on pain management.
posted by Cyrano at 1:07 PM on October 13, 2003

Opiates: They're not just for "junkies" anymore!

I blame the so-called war on drugs, which, imho, should have always been called the war on some drugs; the ones the government deemed evil and the pharmaceutical companies weren't allowed to make megabucks with. Through their portrayal of addicts being no more than low-life, hopeless, weak people who usually hang on a corner looking for yet another hit, and who would rob you for such sooner than work has created a huge division in our so-called progressive society by largely ignoring or excusing abuses of accepted drugs. As long as you could buy your fix from a dealer who works out of an office and plays golf on Wednesday, you weren't a, gasp, drug addict! But look how easily the "disease" spills over into "good" peoples lives, taking with them now their doctors who supposedly prescribed meds with the very best of intent.

Shah! The hypocrisy drives me insane. Nearly everyone enjoys removing themselves from the reality of life's everyday stresses temporarily on occasion, or maybe prefers fast pain relief even when it isn't all that unbearable. More use alcohol for these and it's completely acceptable, as long as no one knows how much you really drink. Others have found pharmaceuticals to be their choice and still stay within those "accepted" bounds. But my recreational use (I buy from those who support terrorism, btw) labels me an addict of the evil variety, and one with obvious deep-seated issues or hereditary afflictions that have infected me, but in spite of something I'm told I didn't create in the first place (birth defect, remember?), if I don't manage it and happen to get caught, the state will cure me through incarceration and enforced treatment.
'Cept if my bank account is large and maybe I call myself W or Rush or, I'll shut up now...

/rant
posted by LouReedsSon at 1:22 PM on October 13, 2003

Davis signed bill SB420 last night, which will create ID cards for medical marijuana users to show to law enforcement officers.

I hope that's a coincidence, but it's awfully funny.
posted by Ufez Jones at 1:24 PM on October 13, 2003

And on the other side of it, doctors are being sued for not providing enough pain relief. I think the family was right to sue, in theory, but with the doctors up against jail time on the other side of it if they over treat pain, it creates something of an impossible situation. You do what you can, conservatively, and hope it's enough and your patient is comfortable and you don't get sued, or you do what you can and make sure it's enough and hope not to go to jail.
posted by Nothing at 1:40 PM on October 13, 2003

People with chronic pain often require and tolerate extremely high doses of opiates (dosage amounts for opiates vary greatly among individuals - what is a near-fatal dose for one person is a safe, effective dose for another - judging "overprescribing" by moving targets like this is ridiculous). Targeting doctors who prescribe amounts appropriate to an individual's needs is a shameful travesty. If the choice is between an individual being comfortable enough that they may even be able to lead some semblance of a normal life thanks to high-dose opioids, and an individual taking lower doses and having to spend all their time in bed due to pain, I don't see how there's any difficulty about the choice. And surely the bottom line is that it should ultimately be the patient's informed choice to make.
posted by biscotti at 2:08 PM on October 13, 2003

> one in five Europeans suffer from "chronic pain."

Is the problem living in pain or just living too damn long? For comparison, average life expectancy of these Europeans was twenty five years. Being a bit past that, I figured my own chronic back pain was just life's way of telling me it's time to shuffle off and let some younger primate have my cave. Consequently I have been pretty damn quiet on the subject; perhaps some of these 1 in 5 feel the same, or could be led to do so if other members of their tribes showed 'em the icebergs and encouraged them to climb on.
posted by jfuller at 2:12 PM on October 13, 2003

It's a pain gettin' da chronic.
posted by inpHilltr8r at 2:39 PM on October 13, 2003

Nice catch, Ufez Jones, I didn't notice that. I wonder if it was intentional. Here's more on SB 420.
posted by homunculus at 2:51 PM on October 13, 2003

Isn't it painfully obvious that the ONLY real reason for maintaining the "War on Drugs" is moralistic?

There are large numbers of Taliban-like fanatics out there who truly believe that "pleasure without pain" is inherently sinful.

They are the ones who really embrace the stereotypes of alcoholics and prostitutes and drug abusers and gamblers as "dying in the gutter." They believe in these images because they have to. They tell themselves that good, religious people who don't *sin* should be rewarded, and scoffers, the irreverent, those laughing heathens *must* be punished. And punished in the after-life just isn't enough.

They must be punished in the here and now.

Back in prohibition days, they were called "Nasty Nellies."

More than anything else, they hate the idea of others having "fun."
posted by kablam at 3:17 PM on October 13, 2003

Ugh, mother fuckers. You should be able to Hydrocodine over the counter, IMO. A copule moron's going deaf isn't to high a cost for me not being in excrutiationg pain from my back. Pigfuckers.

If I had my way, All drugs would be legal. People should make their own choices.
posted by delmoi at 5:49 PM on October 13, 2003

Interesting that in the UK the most common drug for pain relief in extreme cases, such as cancer, is diamorphine, more commonly known by the trade name of Heroin. As far as I know diamorphine is rarely used in U.S. hospitals and I wonder how much this is due to the moral panic that surrounds it's reputation.
Both my parents (one with cancer, one with heart disease) died in hospital, their pain thankfully alleviated by the careful use of diamorphine.
posted by rolo at 3:00 AM on October 14, 2003

Well, the state of California (and apparently Canada also) monitors prescriptions drugs subject to abuse by a system of triplicates.

Every prescription is in three copies - first one is kept by the doctor who must justify his choice of medication and dosage when controlled, second one is kept by the pharmacist who if in doubt may call the physician who issued the prescription and must keep his copy when he is controlled, and the last copy is given to the patient who has proof of the treatment her doctor has administered. Incidentally, the relatively young medical field of Pain Management is subject to very close scrutiny.
posted by ruelle at 11:13 AM on October 14, 2003

"The Supreme Court cleared the way Tuesday for state laws allowing ill patients to smoke marijuana if a doctor recommends it."
posted by homunculus at 4:02 PM on October 14, 2003

Well, the state of California (and apparently Canada also) monitors prescriptions drugs subject to abuse by a system of triplicates.

Apparently not in California anymore:

"Other drug policy reform measures signed by Davis included: SB 151 (Burton, D-San Francisco), which repeals California’s 'triplicate' form requirement and will improve pain management practices for doctors and patients"
posted by homunculus at 6:31 PM on October 14, 2003

Here's a new Newsweek article on opioids: In the Grip of a Deeper Pain
posted by homunculus at 6:42 PM on October 14, 2003

Activists to Ask Arnold to Act on Medical Marijuana in Meeting with Bush
posted by homunculus at 7:30 PM on October 14, 2003

Meanwhile, in Iraq: Drugs crisis threatens to break fragile health service
posted by homunculus at 11:04 AM on October 15, 2003