David Borden, Executive Director, [email protected]
One of my fellow passengers was a woman whose life was filled with pain; I shared a bus with her several times. She was able to bear sitting in her seat while riding from point A to point B, at least somewhat. But walking was too much for her to bear quietly. She would cry out and cry out, again and again. She experienced great agony with every step -- up the stairs, from the door to her seat, back to the door, climbing down again to get out. To call it disturbing would be an understatement. Was nothing to be done for her? Was she receiving medical care? Could her pain be relieved? I'm sure I wasn't the only passenger asking those questions.
I never got those answers for certain. But I did, much later, gain insights as to what the problem might have been. The first one came in fall 1994, when I attended a Drug Policy Foundation conference for the first time. There was a panel of doctors and other experts talking about a drug war problem I hadn't previously heard of, under-treatment of pain due to physicians' hesitance to prescribe narcotics. I sort of understood that. I understood it better half a year later, when I got an e-mail from a pain patient named Skip Baker who was living the problem. (Skip went on to found the American Society for Action on Pain, a group that is no longer running but whose history is a memorable one.)
So while I don't absolutely know for sure, I believe that the mystery was solved for me. This woman, in all likelihood, tried to get pain treatment. But her doctor, whether from ignorance of how pain treatment works (a common malady), unreasonable fear of causing addiction or contributing to drug diversion, or fear of license revocation or criminal prosecution, was unwilling to provide it to her in adequate doses if at all. I am speculating, of course, I don't know her story for sure, and there are some conditions that defy even the balm of heavy opiate doses. But if I'm wrong in this case, it is still the truth for many others.
I don't know how well my fellow Mass. Ave. Bus passenger has survived the 10+ years since then, or if she has survived it. But the pain situation has gone downhill during that time, particularly during the past four years in the face of escalating prosecutions of physicians under the Bush administration and increasing law enforcement propaganda and careless reporting on prescription abuse issues involving opiate drugs, particularly Oxycontin. A committee in the Massachusetts legislature is even examining a proposal to ban Oxycontin prescribing in the Bay State entirely, 10+ years since I witnessed those painful bus rides.
Let's hope that more prudent voices on the committee prevail. Banning a drug that is helping patients with their pain is not a policy reflective of civilized governance in a free society, even if there are some who harm themselves by abusing the drug. Helping people who suffer from or are at risk of addiction is a noble purpose in and of itself, but not one to be pursued to such an extreme degree that patients who need those drugs for pain are subjected to torture by denial of them. Ultimately those who use drugs in ways not recommended bear the responsibility for the consequences of their own choices -- we should not impose additional consequences on drug users as we now do through prohibition laws and punishments, but we should also recognize the individual's primary responsibility in making those choices. Prescription diversion has a minimal impact on drug abuse compared with other types of diversion, with the widespread availability of black market heroin, and with human nature itself most of all. And make no mistake, torture IS what is going on in this issue in this country. I think I saw it on the bus in Boston, I know I've seen it since then, and the research backs this up.
Waiting another 10 years to address this problem would mean 10 more years of lost happiness and ruined or lost lives. No one will be truly safe until Congress and our legislatures, agencies and doctors start dealing properly with the delicate intersecting issues at stake in the drug war. Ten more years would be 10 more years too many.