Pubdate: Thu, 04 Aug 2005
Source: Collegiate Times (VA Tech,  Edu)
Copyright: 2005 Collegiate Times
Contact:  http://www.collegiatetimes.com/
Details: http://www.mapinc.org/media/699
Author: Michael Krawitz
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)

U.S. SHOULD ALLOW DOCTORS TO PRESCRIBE MORE PAIN RELIEF

The human brain is an amazing device. Each day our brain takes in massive 
amounts of information through our ears and eyes, our sense of smell and 
our sense of touch. But what about our sense of pain?

Under normal circumstances people don't give much thought to pain but the 
sensation is very important. Without pain you might walk on sand hot enough 
to fry an egg without noticing. In this way it is a blessing to feel pain. 
Pain helps prevent injury.

Also a blessing, it is difficult to remember pain. You may remember the 
event and that it was painful, such as spraining an ankle. But what happens 
if the pain never goes away? Some injuries and conditions leave permanent 
nerve or structural damage that causes pain that never subsides. Most 
people who experience pain even close to this severe find it is short lived 
and soon forgotten. Once a doctor tried unsuccessfully to reset a bone in 
my arm after an injury. I remember the bones scraping and crunching in his 
hands and how he kept giving me shots of Demerol but the pain was still 
more than I could stand and he had to stop. I can't imagine living with 
pain like that for more than 45 seconds and I really do thank god I can't 
even remember what that felt like. Societies collective lapse of the memory 
of pain helps to explain the epidemic of under treatment of pain.

What epidemic?  My best estimate is that there are more than 75 million 
Americans that suffer long term unrelenting pain. There are many million 
Americans suffering needlessly because of undertreatment of pain. Of all 
the epidemics I have studied the epidemic of under treatment of pain is the 
one that seems the most curable and the most senseless.

Consider the report by Maia Szalavitz, 13 July 2005, New York Times; " EVEN 
as Afghanistan's immense opium harvest feeds lawlessness and instability, 
finances terrorism and fuels heroin addiction, the developing world is 
experiencing a severe shortage of opium-derived pain medications, according 
to the World Health Organization. Developing countries are home to 80 
percent of the world's population, but they consume just 6 percent of the 
medical opioids.  In those countries, most people with cancer, AIDS and 
other painful conditions live and die in agony. The United States wants 
Afghanistan to destroy its potentially merciful crop   But why not bolster 
the country's stability and end both the pain and the trafficking problems 
by licensing Afghanistan with the International Narcotics Control Board to 
sell its opium legally? "

But certainly we, in the USA, have good availability to pain medicine? 
Don't bet too much on that. Again Maia Szalavitz; " Here in the United 
States, only half of all dying patients receive adequate relief, and those 
suffering from chronic non-cancer pain are even more likely to be 
undermedicated. "

There are many reasons why pain is under medicated in the USA. According to 
the 1996 report of the International Narcotics Control Board titled 
"availability of opiates for medical needs" the four main reasons for under 
management of pain is 1 -- "concerns about addiction" 2 -- "insufficient 
training of doctors" 3 -- over burdensome regulations and 4 -- "reluctance 
to prescribe or stock opiates because of concerns about legal sanctions". 
Number 2 is cured by educating doctors and both three and four are 
vanquished with a truce in the drug war so that leaves number one, fear of 
addiction. Consider what the World Health Organization says about addiction 
and pain treatment: " WHO recognizes that the medical use of opioids is 
rarely associated with the development of drug dependence (addiction) and 
further clarifies that a cancer patient who is physically dependent (as 
manifested by withdrawal) is not considered drug dependent (i.e., addicted) 
".  [appx. one percent]

The medical community tries to stay as far away from the subject as they 
can get. And who can blame them? The DEA has targeted doctors for high 
profile prosecutions and even though the DEA claims the percentage of 
doctors they prosecute is small the actual number of doctors willing to 
prescribe strong pain medicine is tiny and shrinking in spasms coinciding 
with every additional doctor imprisoned. Recently in Montana the DEA had to 
face this issue head on when the patients displaced by one of their 
prosecutions found no safe harbor for their medicine despite comforting 
statements made by DEA to the contrary.

One of the most insidious aspects of the war on drugs interference with 
medical practice has to do with a device called a "pain contract". When I 
asked the American Medical Association [AMA] about pain contracts they 
referred me to the American Academy of Pain Management [AAPM] . The AAPM 
promotes the use of a well thought out and fair document called a pain 
attestation. The trouble is that no-one uses the pain attestation and 
instead pain clinics use a patchwork quilt of the quasi legal "pain 
contracts" that call for outrageous and degrading accommodation by patients 
under duress of discontinuance of their needed medicine.

The pain contract makes it clear that you aren't to be trusted like a 
regular patient. You must submit to routine urine drug testing for 
marijuana. One patient tells me that his doctor rolls dice to see who gets 
drug testing.  I can't imagine submitting myself to a lab procedure based 
upon a dice game. You must never ask for additional office visits. You must 
never need more medicine. You must get better; failure to improve will 
result in removal from treatment. I asked a dozen or so doctors from across 
the country about the use of pain contracts. Those in favor of them said 
they were necessary to protect the doctor. Some see the contract as similar 
to a consent form that you sign before surgery.

Doctors opposed to the contracts felt they negated the doctor patient 
relationship and replaced the Hippocratic oath with a law enforcement oath. 
Consider the words of Dr. Fisher from California: " By rejecting the 
essential elements of the standard of care, contracts, as they currently 
exist, guarantee that the therapeutic goal of optimal patient functioning 
will seldom be achieved. In the vast majority of cases they make this an 
impossibility." Or the words of Dr. Adams of the Texas Pain Society: " 
Contracts are supposed to prevent diversion, but there is no evidence that 
they actually do so. The pain contract is nothing more than ritualistic 
behavior in support of a myth fueled by an ideology"

In his great work, Ceremonial Chemistry, Dr. Szasz writes about how doctors 
in the USSR were ordered to give up the Hippocratic oath since doctors in 
the USSR were communist agents of the state and not agents of the 
patient.  In this situation, like in the USSR, doctors are being put in a 
position of working as an agent of the state and not of the patient.

Contracts call for patients to be immediately cut off from opiates for a 
failed marijuana urine test despite bonafide medical science affirming the 
benefit of Cannabis as an adjunct medication to opiates and despite state 
laws allowing for Cannabis use as a medicine. Cannabis helps reduce the 
amount of opiates needed and is extremely useful for patients that cannot 
tolerate opiates side effects. Worst is the fact that some kicked out of 
pain clinics for medical marijuana find their only refuge from pain in 
methadone clinics where they help perpetuate the drug war myths by the 
requirement that they swear they are truly a drug addict before they can 
receive treatment.

Forcing a patient to sign a contract under duress of withholding medicine 
violates a huge list of human and civil rights such as Constitutional 
rights, section 504 of the ADA, Universal Declaration of Human Rights 
(1948), the International Covenant on Civil and Political Rights (1966), 
and the International Covenant on Economic, Social and Cultural Rights 
(ICESCR, 1966). Bottom line is you have a basic human right to access the 
medicine you require.

As a compassionate society proper treatment of pain should be one of our 
highest priorities.

Michael Krawitz is a regular columnist for the Collegiate Times
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MAP posted-by: Beth