Pubdate: Mon, 05 Jan 2004
Source: Watertown Daily Times (NY)
Copyright: 2004 Watertown Daily Times
Author: Philip Terzian
Bookmark: (Oxycontin/Oxycodone)
Bookmark: (Chronic Pain)


WASHINGTON - 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.

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, 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 such as 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 Ashcroft into a man of
science, or puts the cops-in-suits at DEA in charge of the medical

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, painkilling drugs are treated like radioactive
waste, grudgingly distributed and clothed in all the trappings of
criminal law. 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.

Providence Journal
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MAP posted-by: Larry Seguin