On January 20 – inauguration day – the HBO news talk show Real Time with Bill Maher aired its fifteenth season premier. Unsurprisingly, Donald Trump was the topic of the hour. After Maher and his panel of pundits concluded their discussion, the host delivered an editorial monologue analyzing Trump’s electoral victory and offered a provocative comparison:
“Here on inauguration day, in the spirit of new beginnings, liberals have to stop calling Trump voters rubes and simpletons and instead reach out and feel their pain, the pain they insist we didn’t see. And there is ample evidence for that pain. Did you know that of the fourteen states with the highest painkiller prescriptions per person, they all went for Trump? Trump won eighty percent of the states that have the biggest heroin problem… So let’s stop calling Trump voters idiots and fools and call them what they are: fucking drug addicts!”Read More »
I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.
Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.
But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.
Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”
Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.
I didn’t keep up with my drug-related news over the holidays. I didn’t check Facebook or read any blogs. My mother was in town, and I was playing tourist. What could possibly happen, anyway, I thought, with legislators on holiday and courts out of session? Apparently, a lot.
Ed. Note–This post originally appeared on August 1. We removed it briefly while pursuing an opportunity to speak with Rep. Bachmann about the questions posed below. Unfortunately, the Bachmann camp did not respond to our query. We welcome readers’ insights into the candidate’s stances on these issues and urge fellow bloggers and mainstream journalists to ask Bachmann about her approach to drug policy – and pain management praxis in particular – if given the chance.
Points has been investigating the regulation and increasing criminalization of opioid pain medications in the U.S. with posts like Siobhan Reynolds‘ on DEA meddling in pain management practices, Joe Spillane‘s on historical accounts of law enforcement interference in medicine, and Kenneth Tunnell‘s look at the first OxyContin scare. Conservative political news site the Daily Caller (run by formerly bow-tied pundit Tucker Carlson) alleged in late July that Republican presidential candidate Michele Bachmann takes “all sorts of pills” to deal with “incapacitating” migraines. Since narcotic pain relievers are one of several tools in many a migraineur’s survival kit (as well as that of at least one president), that story got us thinking about how the congresswoman’s experience with chronic pain might affect her approach to drug policy. The response to the allegations also illuminates the way in which media discourses work to reproduce normative representations of gender and power, even when media commentators attempt to upend those discourses.
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.
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
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.Read More »
In her fourth in a six-post series for Points, Siobhan Reynolds reviews the policies and judicial precedents that leave doctors unwilling to prescribe opioids to patients in pain. Reynolds focuses in particular on how federal control of the medical profession undermines the political structure of the United States and the opportunities for freedom and experimentation federalism provides.
In an earlier blog post I suggested that I would explain the reasons why physicians are loath to treat pain with opioids despite their notedefficacy; I’ve mentioned that medical professionals don’t like to admit that they are afraid to prescribe these medicines, preferring instead dole out far more dangerous non-controlled drugs on the grounds that opioids are “bad” in some special way having nothing to do with their actual utility or safety profile. In this post, I will examine how the profession developed such a seemingly irrational blind spot where opioids are concerned. This blind spot has its roots in the interpretation and enforcement of the Harrison Narcotics Tax Act of 1914 and the more recent Controlled Substances Act (initially passed in 1970).
Years ago, when I sat at my computer in my kitchen in New York City, wondering how in the world it was that doctors simply refused to effectively manage their patients’ pain, I researched the law myself.Read More »
In her third guest post for Points, pain relief activist Siobhan Reynolds traces the unraveling of the doctor-(pain)patient relationship under drug prohibition.
Perhaps the most disturbing consequence of opium prohibition, and the one least talked about in polite company, is the steady degradation of the doctor/patient relationship that has occurred since prohibition’s inception. In poor countries, where opioids are not at all available, physicians speak truthfully to their patients when they tell them that they have nothing with which to relieve their pain. In countries like the United States, where opioid pain medications are ostensibly legal but where physicians have been intimidated into withholding pain treatment, the doctors feign their impotence. There is certainly a great deal of pain relief to be found in opioid medications, and they are stacked on the pharmacist’s shelves. But physicians in the US are jailed – often arrested by SWAT teams, de-licensed and destroyed financially – for treating pain in a manner inconsistent with the opinions of government lawyers and agents. If you ask the physician who refuses to treat pain with opioids if his fear of official attention is the cause of his failure to serve his patient, you will likely meet with something quite different than such a humble confession. Instead, you will hear about how addictive the opioids are, or the doctor will say that their use should be confined to the care of the terminally ill, when addiction is not a concern. And he will extol the virtues of the anti-inflammatory and of psychiatric drugs. He will talk about the miracle of biofeedback and the importance of a positive outlook on life in the treatment of pain.
All of these responses have their place in the treatment of pain after the pain has been medically controlled. But recommending these adjustments as if they replace the pain relief provided by opioids is like telling a woman whose house is burning that a simple glass of water will fix her problem or a diabetic that he must exercise to earn his insulin. To a person in suicidal levels of pain, this kind of dissembling amounts to psychological and physical abuse. And yet this conversation between doctor and patient is par for the course under drug prohibition. It is a refrain patients hear over and over, until they finally stop searching for relief and eventually give up on living all together.
The fundamental truth that confronts anyone concerned with the quality of the doctor/patient relationship under drug prohibition – namely, that doctors have in essence been turned against the interests of their patients – remains almost entirely unacknowledged by the profession as a whole. Read More »
Siobhan Reynolds’ most recent guest post to this blog does an outstanding job of making the case that we (meaning both society writ large and the medical profession more generally) have utterly failed to address problems of chronic pain, and that these failures have a great deal to do with “the context of drug prohibition.” Reynolds observes: “The system-wide denial of humane and effective treatment is covered up by the fear campaign that has been hammering away at our consciousness since the dawn of drug prohibition–a fear campaign masquerading as a public health initiative.”
The phrase “the dawn of drug prohibition” led me to ask myself–just what are the roots of our contemporary struggle to employ opiate analgesics effectively and appropriately, and how deep are they? Here’s a bit of what we, as historians, know about the case of the United States.Read More »
In her second guest post for Points, pain relief activist Siobhan Reynolds looks at the ways in which drug war hysteria has warped public and political perceptions of pain management prescribing practices.
On April 20, the FDA, the DEA and the Office of National Drug Control Policy, along with a host of other federal agencies, announced the rolling out of REMS, or “Risk Evaluation and Mitigation Strategy,” a new federal policy that purports to confront what these agencies call the “epidemic” of prescription opioid abuse. Among REMS’ proposed solutions to the problem is physician education by DEA agents– federal law enforcement officers
with no medical training. Alongside the REMs announcement, of course, came a propaganda campaign justifying the action: articles in newspapers, magazines, law journals and even medical outlets that decried the sharp rise in overdose deaths that have resulted, the government claims, from doctors’ increased prescription of opioids over the past several years. There’s only one problem with all the hype: the data upon which such frightening claims are made is wholly unreliable.