We Are the Drug War: Prohibition as Success

In her final guest post for Points, Siobhan Reynolds asserts that the oft-repeated claim that the War on Drugs has failed should be reassessed from the point of view of those who profit from its outcomes. Looked at from that perspective, Reynolds sees opiate regulation as central to the drug war’s astonishing success.

Protesters Rail against the Drug War with Puns

Drug policy reformers have rallied for an end to drug prohibition calling it a dismal failure. To my mind, however, in order to understand this thing that has taken on a life all its own and to ultimately change course, if that is possible, one has to stop looking at the drug war as a failure and instead regard it as a spectacular success. There’s no denying that drug war policies and practices have turned physicians against the interests of their patients, been wildly expensive, destroyed the criminal justice

Activists Protest Drug War Over-Incarceration

system, and facilitated the incarceration of people in the United States to a degree that would make Stalin or the Chinese envious. People who value civil liberties above all other social goods undoubtedly consider such developments evidence of failure. But these chilling outcomes do benefit some. A mature view would necessitate that we look at who profits under drug prohibition in order to truly judge what it has become.

A good friend of mine and former Pain Relief Networkboard member, James Stacks, makes the excellent point that the stellar pharmacological power of opioids was in essence harnessed by the medical profession in the early part of the twentieth century, back when doctors were widely known as jumped-up barbers and generally unable to do anything about most illnesses. At the advent of drug prohibition, medicine had not yet employed antibiotics, average life expectancy for a male in the United States was 48 years, surgery was performed in unsterile theaters, and people died of whatever came their way.

As a result of the criminalization of all derivatives of the opium poppy, perhaps the most miraculous of natural substances, doctors managed to corner the legal market in their dissemination and so enhance their healing and palliative prestige among the general public. Says Stacks,

[Perhaps it was] Siobhan who mentioned that doctors, given a scenario where they could only have one drug to use in their practice, would likely choose an opioid. I think the profession of medicine was an early player in this game, and a large part of the growth of their profession in the twentieth century was based in getting opioids off the free market and under their exclusive control. [...] Opioids solved many problems for medicine, and the medical profession was able to make use of this powerful tool to effect a very broad range of interventions. The breadth of these interventions had the natural effect of leaving the uninformed and uneducated with the impression that entire ranges of problems had been solved independently. That is, it made the profession appear much more competent than it really was, sort of in the same way a scatter gun makes a single person appear to be a “better shot,” unless the judge understands why the person with the scatter gun never misses.

  

According to this exhibit at Southern Illinois University’s Pearson Museum, doctors were basically lawyers, and pharmacies were more like bars.

As government control became more and more absolute, physicians were increasingly required to go the extra mile to prove that the pain patients they were seeing were in fact people in pain rather than addicts seeking maintenance. Physicians were and are required to see patients regularly and order all kinds of tests in order to document a “legitimate medical relationship,” a situation that the medical profession and tertiary professions have exploited handsomely.

People in pain who would be quite satisfied with picking up their prescriptions every six months are now required to go to the doctor every month, sometimes every two weeks. The general unavailability of prescribed opioids due to fear of official sanction puts patients into the unenviable position of having to capitulate to the demands of orthopaedic surgeons who insist that they try any and all surgeries in order to prove that they don’t want the medications to get high.  The pharmaceutical industry makes all kinds of money it wouldn’t otherwise because doctors prescribe anti-inflammatories, anti-anxiety medications, anti-depressants instead of the tried and true opioids.

Additionally, tens of millions of Americans see their health deteriorate due to untreated pain, the physical consequences of which include the development of obesity, diabetes, heart disease and many other complications. This creates perhaps the largest area of inflated profit. As the modern system has all kinds of expensive interventions at the ready as treatments for these conditions, the unavailability of pain medicine has turned all of us into a herd of cash cows for the mega hospital/insurance industry.

Patients complain that their quality of life should be put before profits, but no one is there to hear them. Congress now works to shield these corporate interests from the complaints of the patients and their families. And the mainstream press will not publish patient accounts of what it is like to live in this pariah state, knowing that one is not being helped by the medical machine but is rather being fed to it.

“After World War II, the United States, along with Britain and France, recurrently used both drug networks and terrorist groups as assets or proxies in the Cold War,” Peter Dale Scott writes in his painstakingly documented book American War Machine (one in a long line of scholarly works probing the deeper motives for the War On Drugs). As Scott shows, drug prohibition became intertwined with the CIA’s efforts to dominate the globe over the last sixty-odd years. Were pain medications to become actually legal and readily available through medical practice, the very fabric of American foreign policy would unravel.

Us, as the Drug War

When seen in this context, it isn’t difficult to understand why opium prohibition is such a sacred cow, its elimination “off the table” even amongst leading drug law reform organizations. The profits from illegal drugs have become a second economy throughout the world–and of course a significant source of income for America’s political class–in such a way that it no longer makes sense to talk about the War on Drugs as something we as a nation do. The drug war forms the structure of our political system both domestically and abroad. It is, rather, what we are.

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3 thoughts on “We Are the Drug War: Prohibition as Success

  1. Well said, and essentially what I, and others, have been writing about for years now: the Drug War has simply become far too profitable in terms of money and political and other sorts of power for it to be allowed to end. Even the slow, agonizing torture and destruction of 116 million citizens whose only crime was to become permanently injured, and permanently ill and degenerating secondary to the pain of the injuries. In many if not most cases, this permanent chronic pain is due to workplace safety deregulation, insurance company refusal to pay out what they contracted to pay, and physician refusal to treat chronic pain correctly out of ignorance fostered by propaganda and out of sheer terror of being railroaded into prison like too many other doctors for simply doing their jobs.

    Chronic pain patients (CPPs) are forced to allow surgeries and other procedures, often repeatedly even though these never worked for most patients in the past. Then, when the patients finally refuse to play that game any longer and demand relief from the pain that has destroyed his/her life and lost them everything they treasured as well as any peace of mind, ability to rest, health, a healthy self-image, the spouse they were with when they were finally diagnosed or became “permanent and stable” and usually any children, a home, vehicle, and pretty much you-name-it, they may be given a handful of weak opiates, designed for, and suggested by the PDR for “mild to moderate pain.” Even that tiny amount of partial relief is like a ten thousand candlepower search light in the small, dark room room where they’ve been living for years now, if for no other reason because it shows them what’s possible. With something a bit stronger they KNOW they could get off the damned, hated couch or out of bed, they might be able to start walking again. Maybe they could even have a LIFE again, go back to work part time! That is the beginning of a whole new phase, one that probably sees more suicides than perhaps any other time.

    The drugs exist, they know that now, and they WORK! There’s no possible reason for such patients not to get all the pain relief – and so all the regained functionality – that medicine can provide to them, and they KNOW IT! In many cases, they learn, if they get enough relief to allow the nerves to rest, to stop the ceaseless, nonstop firing that destroys many of them and causes them to recruit other nerves thus spreading the pain, those nerves may actually begin to heal! Opiates, they learn, can actually CURE chronic pain, at least some of the time. But that is when the DEA decides to step in.

    The patient has started cleaning house again, cooking real meals and washing the dishes; s/he may even have started looking into Vocational Rehab, thinking s/he might be able to work again, at least part-time. The DEA, though, blasts through the open doors of the clinic as though it was a fortified crack house, holds automatic rifles one women and children, even on infants in diapers indiscriminately. (I’ve always wondered if they really expect some toddler to haul an AK-47 out of a diaper and start blasting away…). They haul half-dressed patients out of exam rooms, force office people out of the office and start grabbing up charts by the pallet-load and hauling them away as “evidence,” usually never to be seen again. The patients, unable to get copies to take to another doctor, have problems getting seen. The real reason for that trouble, though, is that even doctors as far away as two states over are afraid that taking on the former patient of a doctor raided by the DEA might attract them to their own offices next. patients can’t even get insulin or heart medications. Some end up in ERs or even CCU in catastrophic withdrawals. The standard treatment for withdrawals, especially in debilitated pain patients, and even more so in older pain patients, is to STOP the withdrawals with opiates, then titrate them down slowly. Instead, patients of a “pill mill doctor” are allowed to scream in returned pain PLUS withdrawals, puke, urinate and defecate on themselves in the bed, writhe in bone-cracking muscle spasms, stay awake for days in agony and sweat rivers until the withdrawals are over. Then it’s just the pain, untreated again. A doctor giving opiates to “one of THOSE patients” might find himself in court beside his unfortunate colleague; better to let the patient suffer, even die if necessary. It’s simple self-defense.

    Incidentally, the very first thing the DEA does is make sure the local media is there, forewarned, cameras rolling and ready to go as the courageous cops in armor and with enough firepower to retake the South blast through the (unlocked, open) doors of another clinic. They know when they get there that this is another infamous “Pill Mill doctor” who has been addicting their unsuspecting townspeople. The doctor and the patientw get no warning at all, of course, and since pain patients are there to get refills of their medications, and because “modern” pain care requires that they go month to month, they’re already out of medications, or only days away from being out. Guaranteed though, after t Well said, and essentially what I, and others, have been writing about for years now: the Drug War has simply become far too profitable in terms of money and political and other sorts of power for it to be allowed to end. Even the slow, agonizing torture and destruction of 116 million citizens whose only crime was to become permanently injured, and permanently ill and degenerating secondary to the pain of the injuries. In many if not most cases, this permanent chronic pain is due to workplace safety deregulation, insurance company refusal to pay out what they contracted to pay, and physician refusal to treat chronic pain correctly out of ignorance fostered by propaganda and out of sheer terror of being railroaded into prison like too many other doctors for simply doing their jobs.

    Chronic pain patients (CPPs) are forced to allow surgeries and other procedures, often repeatedly even though these never worked for most patients in the past. Then, when the patients finally refuse to play that game any longer and demand relief from the pain that has destroyed his/her life and lost them everything they treasured as well as any peace of mind, ability to rest, health, a healthy self-image, the spouse they were with when they were finally diagnosed or became “permanent and stable” and usually any children, a home, vehicle, and pretty much you-name-it, they may be given a handful of weak opiates, designed for, and suggested by the PDR for “mild to moderate pain.” Even that tiny amount of partial relief is like a ten thousand candlepower search light in the small, dark room room where they’ve been living for years now, if for no other reason because it shows them what’s possible. With something a bit stronger they KNOW they could get off the damned, hated couch or out of bed, they might be able to start walking again. Maybe they could even have a LIFE again, go back to work part time! That is the beginning of a whole new phase, one that probably sees more suicides than perhaps any other time.

    The drugs exist, they know that now, and they WORK! There’s no possible reason for such patients not to get all the pain relief – and so all the regained functionality – that medicine can provide to them, and they KNOW IT! In many cases, they learn, if they get enough relief to allow the nerves to rest, to stop the ceaseless, nonstop firing that destroys many of them and causes them to recruit other nerves thus spreading the pain, those nerves may actually begin to heal! Opiates, they learn, can actually CURE chronic pain, at least some of the time. But that is when the DEA decides to step in.

    The patient has started cleaning house again, cooking real meals and washing the dishes; s/he may even have started looking into Vocational Rehab, thinking s/he might be able to work again, at least part-time. The DEA, though, blasts through the open doors of the clinic as though it was a fortified crack house, holds automatic rifles one women and children, even on infants in diapers indiscriminately. (I’ve always wondered if they really expect some toddler to haul an AK-47 out of a diaper and start blasting away…). They haul half-dressed patients out of exam rooms, force office people out of the office and start grabbing up charts by the pallet-load and hauling them away as “evidence,” usually never to be seen again. The patients, unable to get copies to take to another doctor, have problems getting seen. The real reason for that trouble, though, is that even doctors as far away as two states over are afraid that taking on the former patient of a doctor raided by the DEA might attract them to their own offices next. patients can’t even get insulin or heart medications. Some end up in ERs or even CCU in catastrophic withdrawals. The standard treatment for withdrawals, especially in debilitated pain patients, and even more so in older pain patients, is to STOP the withdrawals with opiates, then titrate them down slowly. Instead, patients of a “pill mill doctor” are allowed to scream in returned pain PLUS withdrawals, puke, urinate and defecate on themselves in the bed, writhe in bone-cracking muscle spasms, stay awake for days in agony and sweat rivers until the withdrawals are over. Then it’s just the pain, untreated again. A doctor giving opiates to “one of THOSE patients” might find himself in court beside his unfortunate colleague; better to let the patient suffer, even die if necessary. It’s simple self-defense.

    Incidentally, the very first thing the DEA does is make sure the local media is there, forewarned, cameras rolling and ready to go as the courageous cops in armor and with enough firepower to retake the South blast through the (unlocked, open) doors of another clinic. They know when they get there that this is another infamous “Pill Mill doctor” who has been addicting their unsuspecting townspeople. The doctor and the patientw get no warning at all, of course, and since pain patients are there to get refills of their medications, and because “modern” pain care requires that they go month to month, they’re already out of medications, or only days away from being out. Guaranteed though, after this, NO doctor in town, no doctor in the state and maybe none for a couple of states over will have anything to do with them. Besides, the DEA classifies “traveling long distances to see a doctor” to be “drug-seeking behavior,” meaning this is probably an addict. It used to be called “tainting the jury,” but it’s been ruled that the jury isn’t tainted at all by this kind of thing, so now it’s de riguer.

    Some of those abandoned patients choose to take their own lives. It’s just too much, having to start over again, finding a doctor willing to treat who might be hundreds of miles away. It could take another year of untreated agony, of abuse in emergency rooms when the pain just gets to be too much, of trying to justify the need to have it controlled – of having to go through the humiliation again and again, along with all the symptoms. And any new doctor who’s actually willing to talk will likely want to do the spinal injections again, though just like last time and the time before hat, they’ve only ever caused more agony. He’ll want to start the patient out on the weakest drugs first, and then build up to something stronger – if it’s actually needed. Yes, the doctor has insinuated that the patient is likely lying. Piss tests at random, pill counts, all the rest, all have to begin again, save for the patients who opted not to go through it all again, and died by their own hands. Even those deaths are used against the doctor now under attack. One was charged with murder for having addicted his patient so badly he took his own life rather than live without the opiates. Another was charged with murder when a patient died with opiates in his system in a car wreck – he was a passenger.

    The DOJ has blackmailed patients into lying on the stand, in one case saying they traded sex for drugs. Even when it came to light, the verdict was even reviewed; the doctor stayed in prison. The DOJ can attack FOREVER. If the DEA hasn’t already stolen any property and accounts via civil forfeiture, the DOJ does, making sure the doctor is too poor to afford a decent lawyer. cops can add the proceeds from such misuse of civil forfeiture to their own departments budgets though, and they’ve learned it goes much better when they share that money 9and cars and such sometimes) around with other agencies. Everybody makes out well. Except the doctor, of course. As Siobhan has written, in court, ordinary billing practices are made to look like money laundering.The differences in chronic pain that require (usually) much larger, though still perfectly safe, doses of opiates to control it than acute pain, which goes away when the patient heals, unlike CP. It can be made to appear that the only possible reasons for those large doses, those HUGE numbers of pills, was to sell them on the street. Paraphrasing Siobhan again, “To be accused is to be destroyed,” guilt or innocence notwithstanding. And because the targets are usually older physicians who have had the time to pay off their student loans and buy some real estate, maybe save something for retirement and so on (all of which is stolen by the government, usually before the doctor even goes to trial).the “take” by the cops is substantial. They actually count on this income in their budgets! And because of their age, these doctors are usually effectively sentenced to life in prison. For doing their jobs and following their oaths to relieve suffering, those who actually took the Hippocratic Oath. I understand it’s gone out of style amongst younger doctors.

    So the DEA makes out like bandits (I suppose that’s appropriate enough), or local cops if it was their bust. The private prison industry is paid “x” amount of money for every prisoner they warehouse; they’ve backed all the most punitive legislation, laws that are likely to increase prison populations. The Prison Guards Union paid out $2.5 million in California to defeat Prop 8 a few years ago – a marijuana decrim law. They need MORE prisoners, not fewer. The MSM makes money with all the great footage and stories of these “pill mill” busts, so they do well from the situation. Judges with political ambitions get some great stuff for their resumes as well.
    his, NO doctor in town, no doctor in the state and maybe none for a couple of states over will have anything to do with them. Besides, the DEA classifies “traveling long distances to see a doctor” to be “drug-seeking behavior,” meaning this is probably an addict. It used to be called “tainting the jury,” but it’s been ruled that the jury isn’t tainted at all by this kind of thing, so now it’s de rigueur.

    Some of those abandoned patients choose to take their own lives. It’s just too much, having to start over again, finding a doctor willing to treat who might be hundreds of miles away. It could take another year of untreated agony, of abuse in emergency rooms when the pain just gets to be too much, of trying to justify the need to have it controlled – of having to go through the humiliation again and again, along with all the symptoms. And any new doctor who’s actually willing to talk will likely want to do the spinal injections again, though just like last time and the time before hat, they’ve only ever caused more agony. He’ll want to start the patient out on the weakest drugs first, and then build up to something stronger – if it’s actually needed. Yes, the doctor has insinuated that the patient is likely lying. Piss tests at random, pill counts, all the rest, all have to begin again, save for the patients who opted not to go through it all again, and died by their own hands. Even those deaths are used against the doctor now under attack. One was charged with murder for having addicted his patient so badly he took his own life rather than live without the opiates. Another was charged with murder when a patient died with opiates in his system in a car wreck – he was a passenger.

    The DOJ has blackmailed patients into lying on the stand, in one case saying they traded sex for drugs. Even when it came to light, the verdict was even reviewed; the doctor stayed in prison. The DOJ can attack FOREVER. If the DEA hasn’t already stolen any property and accounts via civil forfeiture, the DOJ does, making sure the doctor is too poor to afford a decent lawyer. cops can add the proceeds from such misuse of civil forfeiture to their own departments budgets though, and they’ve learned it goes much better when they share that money 9and cars and such sometimes) around with other agencies. Everybody makes out well. Except the doctor, of course. As Siobhan has written, in court, ordinary billing practices are made to look like money laundering.The differences in chronic pain that require (usually) much larger, though still perfectly safe, doses of opiates to control it than acute pain, which goes away when the patient heals, unlike CP. It can be made to appear that the only possible reasons for those large doses, those HUGE numbers of pills, was to sell them on the street. Paraphrasing Siobhan again, “To be accused is to be destroyed,” guilt or innocence notwithstanding. And because the targets are usually older physicians who have had the time to pay off their student loans and buy some real estate, maybe save something for retirement and so on (all of which is stolen by the government, usually before the doctor even goes to trial).the “take” by the cops is substantial. They actually count on this income in their budgets! And because of their age, these doctors are usually effectively sentenced to life in prison. For doing their jobs and following their oaths to relieve suffering, those who actually took the Hippocratic Oath. I understand it’s gone out of style amongst younger doctors.

    So the DEA makes out like bandits (I suppose that’s appropriate enough), or local cops if it was their bust. The private prison industry is paid “x” amount of money for every prisoner they warehouse; they’ve backed all the most punitive legislation, laws that are likely to increase prison populations. The Prison Guards Union paid out $2.5 million in California to defeat Prop 8 a few years ago – a marijuana decrim law. They need MORE prisoners, not fewer. The MSM makes money with all the great footage and stories of these “pill mill” busts, so they do well from the situation. Judges with political ambitions get some great stuff for their resumes as well. The DEA cops and others get their promotions and their moment to be “Drug War Heroes” on TV for twenty seconds. There’s more, but I’m sure you can find it or figure it out yourselves easily enough. It’s just all great PR, great profits and good feelings all around. Unless you’re a patient in crippling pain that never goes away, and you’re in America. Then you’re pretty much screwed, and may as well just die and save yourself a lot of suffering and abuse. After your insurance has paid out everything it’s going to pay, that is.

    Ian.

  2. No need to apologize for the length, Ian, but thanks for replacing the duplicate post with this shorter apology, anyway. And thank you for your response. We always appreciate having people engage with the blog, no mater how long or short their comments.

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