THE WAR ON DRUGS TAKES A PAINFUL TURN
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
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.