This may be a story that never goes away in our lifetimes. With the graying of America now well underway, it’s likely to get worse. When we last visited the ugly synthesis between politics, the War on Drugs, and chronic pain relief, there were many worthy comments, a number of which came from both those suffering and those who prescribe or fill some of the most potent painkilling narcotics available commercially in the U.S.
Since that post, several new bills intended to fight the War on Drugs have passed or are under consideration. One that is likely to affect you or someone you might know is the Comprehensive Addiction and Recovery Act. It’s a law making it tougher for retirees on Medicare to get prescription pain relief by restricting all pain-related prescriptions to a single doctor, placing their private medical care even more under the ever-expanding cancer of the FDA and DEA:
The bill comes as multiple levels of government are attempting to deal with the growing crisis of opioid misuse and overdose deaths. It has been a topic on the presidential campaign trail for candidates of both parties. The White House fiscal 2017 budget includes a $1.1 billion request that focuses on improving access to medication-assisted treatment. Another likely amendment to the bill would allow the CMS to restrict some Medicare Part D patients to using a single prescriber and pharmacy in an attempt to cut down on “doctor shopping" for opioid prescriptions.
If you’re a doctor, a pharmacist, a pain patient, or just happen to be mortal, you’ll want to know more.
Now, before anyone goes on a tirade against the medical professions, let’s mention the real reason doctors and pharmacists have to be so careful: It’s the fucking War on Drugs. The DEA and other agencies can lift the license of a doctor or pharmacist on little more than a whim. No license means no job, and these are jobs that require a ton of training at significant personal investment of time and money on the part of the aspiring medical or pharmacy student. They can also bring them up on charges—doesn’t matter if the charges have any merit, it will still wind its way through federal court at great expense. They can also seize the doc or pharmacist’s property including all their equipment, their office space, their patient records, and their bank accounts without even charging them with a crime—actually, they can do that to all of us. On the latter, even local county sheriffs and small town police departments have gotten in on the lucrative seizure schemes.
That being said, when this subject comes up, all too often a medical professional weighs in to comments with something along the lines of “there’s nothing worse than an opiate addict in the throes of withdrawal.” Let’s challenge that premise: It’s easy to think of a lot worse things, even if we confine ourselves only to the full spectrum drug addictions. A veteran IV heroin addict in full blown withdrawal is one of the easiest patients on Earth to treat. Within minutes of taking a single oral dose of several well-known, safe, cheap substitutes, the patient will experience substantial, measurable relief. If the treating physician has the professional freedom to experiment with those substitutes, the worst withdrawal symptoms can be virtually medicated away into near non-existence within a few hours.
Yes, there are often longer-term behavioral issues that are a conundrum. But short term, if every medical problem was this easy to treat, we would live in a comparative paradise and probably be working on immortality. So can we please dispense with this absolute fiction that opiate addiction is the worst or anywhere close to the worst medical problem a patient can suffer?
The other common refrain is that doctors don’t want their patients to get addicted to painkillers. Given that so many have bought into the worst-problem-on-the-planet nonsense, it’s easy to understand why. But in the case of terminal disease or chronic progressive conditions, the patient will probably be taking these meds for their rest of their life anyway, a point that seems lost on some in the healthcare and police fields. It’s a good thing we don’t view other substances the same way. Imagine if insulin was viewed as an addictive drug and restricted, or if lawmakers tried to legislate it out of existence on the bankrupt moral reasoning that, hey, diabetics should try alternative methods first no matter how ineffective or unpleasant the consequences, because us non-diabetics think insulin withdrawal is a terrible fate to be avoided at all costs …
Of course, the vast majority of pain patients do not go on to develop a debilitating illicit addiction compounded by neolithic attitudes and authoritarian bureaucracies. I have had to come off of a fairly heavy painkiller regimen at least a dozen times over the past 10 years, thanks entirely to the same War on Drugs I’m writing about today. The worst I’ve ever experienced was a barely noticeable day or two of—and apologies if this is TMI for some of you—being able to poop a little better and maybe, once or twice, some slight chills and sweating. All of which were easily addressed with over-the-counter medications. It’s just not that bad, folks. It’s more than worth it to experience long periods of relief.
Given the professional stakes, I suppose we should be thankful for getting any narcotics legally at all. It’s a good thing we do, because those kinds of meds are absolutely necessary. Human beings perceive different kinds of pain very differently. I’ve seen a Special Forces badass who barely winced at kidney stones flopping around like a frog on a hotplate from a minor wrist fracture. I’ve seen a brain cancer patient decline any pain relief after coming to in recovery with big, bloody staples poking out of her skull, and watched that same patient writhe in agony all night long from a routine tooth ache.
That doesn’t even scratch the surface of the chronically or terminally ill. For many of those folks fighting a progressive condition or trapped in a dying body wracked with intractable pain, the only thing that will allow their remaining lives to be rich and fulfilling may be the most powerful narcotics medical science has discovered.
Denying them that relief to serve an ill-conceived, clearly failed policy cooked up more than a century ago isn’t a War on Drugs. It’s not even much of an effective war on illicit drug dealers whose numbers have remained stubbornly constant throughout it. But it has metastasized into a war on the most vulnerable of us all: The poor, the elderly, the injured, and the dying.
Forcing retirees to go through a single doctor guarantees needless suffering. We already have laws in many states requiring written prescriptions for painkillers to be turned in by the patient to the pharmacist, which already puts an inconvenient obstacle between the patient and treatment. Sooner or later, that doctor won’t be on call or be unavailable, or the patient will be out of the county, or something will happen that interferes with that process. That won’t stop the drug trade, but it will be a pain in the neck for law-abiding patients seeking relief.