By Guest · Jan 11, 2004 ·
  1. Guest

    Everyone's had a good laugh this season at Rush Limbaugh's expense:
    The news that Mr. Know-It-All Conservative was addicted to
    prescription painkillers was nearly as pleasing to critics as the
    prospect of his indictment for buying controlled substances. Not since
    the pursuit of Linda Tripp by a zealous prosecutor in Maryland has
    there been such excitement among people ordinarily skeptical about law

    Yet Limbaugh is more emblematic than people might imagine. It is
    estimated that some 50 million Americans suffer chronic, sometimes
    debilitating, pain of some sort, and medical progress to treat this
    human torment is on a collision course with the War on Drugs.

    Physicians who prescribe painkillers, especially such effective
    morphine-based nostrums as OxyContin and Lortab, to suffering patients
    are now treated with suspicion by agents of the federal Drug
    Enforcement Administration. Undercover "patients" are sent to doctors'
    offices with fraudulent complaints, and pharmacists are directed to
    report "suspicious" patterns of pain relief. Some physicians who
    specialize in pain relief have been arrested, some indicted and tried,
    and a few have been imprisoned. Many have lost their licenses to
    practice medicine, and all have incurred mountainous legal bills.

    No doubt, there are some substandard doctors out there: They may be
    addicted to narcotics themselves, or they may trade prescriptions for
    cash or favors. But there is a large difference between purposefully
    defying the law for profit and relieving people's chronic pain. That
    the frontiers of pain relief involve opiates fraught with emotion and
    history -- morphine, opium, etc. -- seems to have dangerously
    distorted civic judgment. After a prominent Washington-area physician
    was indicted for prescribing large doses of OxyContin, Attorney
    General John Ashcroft spoke as if he had nabbed a Colombian drug
    kingpin: The pursuit of Dr. William Hurwitz, said Ashcroft, shows "our
    commitment to bring to justice all those who traffic in this very
    dangerous drug."

    Unfortunately, it tells us something about the national state of mind
    when a singularly effective pain-relieving narcotic is regarded as a
    "dangerous drug." No doubt, drugs like OxyContin are "dangerous" in
    the sense that, as narcotics, patients can become dependent on them,
    and they should be consumed only under a physician's supervision. But
    what is it about the effective relief of pain that transforms a
    lawyer-politician like John Ashcroft into a man of science, or puts
    the cops-in-suits at DEA in charge of the medical profession?

    Part of the dogma, I suppose, is a vestige of the notion that
    suffering is good for the soul. The United States is particularly
    backward in its presumption that pain may be deserved and ought to be
    endured, and that the pitfalls of relief -- addiction, dependence --
    are infinitely worse than the agony itself. This principle is applied
    to people dying of cancer, children in torment, patients in their 90s.

    Addiction to any sort of opiate can be dangerous, but in the present
    scheme of things, it largely depends on the particular kind of opiate:
    Your dependence on a dry martini every evening is acceptable, even
    convivial; your daily ministration of Demerol is evidence of
    depravity. To that end, pain-killing drugs are treated like
    radioactive waste, grudgingly distributed and clothed in all the
    trappings of criminal law.

    Last summer, my son had surgery in Boston, and in the immediate
    aftermath of an eight-hour procedure, the machinery that injected his
    narcotic inevitably malfunctioned. Needless to say, it was the middle
    of the night, the "pain specialist" on call was unable to attend, and
    the key required to administer the drug (not to mention the authorized
    nurse) could not be found. In due course, another nurse administered
    relief by injection, but not until several hours of post-operative
    misery had passed -- all unnecessary, and all designed (I presume) to
    prevent his parents from stealing the drug from their suffering
    offspring and selling it on the Harvard campus.

    The paradox here is that the science of pain relief has advanced
    steadily in recent years, and people who endured years of chronic
    torture are now able to control and overcome discomfort with new drugs
    and new specialists devoted to pain management. At the same time, the
    War on Drugs has followed the pattern of bureaucratic growth, and
    revised and expanded its power over citizens. Having failed to affect
    the heroin trade, or reduce the demand for designer drugs, the DEA is
    now battling the healing art.

    Instead of finding doctors to alleviate their torment, patients will
    find SWAT teams wrestling physicians to the ground. In pain? Take two
    aspirin and call Dr. Ashcroft in the morning.

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