Saturday, October 6, 2012

Licensed Pushers

The opiates that killed Jaclyn Kinkade were not trafficked by the Mexican or Colombian drug cartels. They were prescribed by duly licensed professionals, distributed by duly licensed pharmacies and produced by reputable pharmaceutical manufacturers.

In some cases, I believe, the expense was covered by health insurance. We’re a compassionate people, after all.

One sees the value in the libertarian position that narcotics should be legalized, but, truth be told, they already are.

The Wall Street Journal reports this morning on the epidemic abuse of prescription drugs, most especially painkillers:

The U.S. spends around $15 billion a year fighting illegal drugs, often on foreign soil. But America's deadliest drug epidemic begins and ends at home. More than 15,000 Americans now die annually after overdosing on prescription painkillers called opioids, according to the Centers for Disease Control and Prevention—more than from heroin, cocaine and all other illegal drugs combined.

Rising opioid abuse means that drug overdoses are now the single largest cause of accidental death in America. They surpassed traffic accidents in 2009, the most recent CDC data available.

Paradoxically, the legality of prescription painkillers makes their abuse harder to tackle. There is no Pablo Escobar to capture or kill. Authorities must contend with an influential lobby of industry representatives and doctors who argue against more restrictions, saying they would harm legitimate patients. And lawmakers have been reluctant to have the federal government track Americans' prescriptions, leaving states to piece together a patchy, fragmented response.

The problem does not just involve painkillers. Who can forget Barbara Gordon’s memoir of her Valium addiction: I’m Dancing As Fast As I Can.

And then there was Elizabeth Wurtzel’s story of her Ritalin addiction: More, Now, Again: A Memoir of Addiction.

When it comes to painkillers the authorities are on the case. They have been prosecuting many of Kinkade’s licensed pushers.

One doubts that very many physicians have been held to account for overprescribing Valium.

For her part Wurtzel did not, as I recollect, have any especially negative feelings toward the physician who kept writing her prescriptions, often without seeing her in person.

Most internists refuse to prescribe painkillers except in extreme cases. Another class of physicians, specializing in pain management is clearly more expert and, the Journal article suggests, less scrupulous. 

Gordon got her Valium from a psychiatrist. Wurtzel got her Ritalin from a psychiatrist.

One appreciates the difficulties that a physician faces. When a Jaclyn Kinkade insists that she is suffering from severe back pain, even when tests show that nothing wrong with her back, what is a physician to do?

Addicts are very persuasive. They are exceptionally good liars. Unless a physician has superhuman perceptual powers, he will have a great deal of difficult telling the difference between a drug addict and someone who is really in pain.

Then again, drug addicts are often in pain. They can be in pain from withdrawal; they might even be suffering psychological pain.

Jaclyn Kinkade was also prescribed psychotropic medication.

People who are depressed often report that they are in agony. Theirs is mental anguish. It is more difficult to treat and to understand than physical pain.

Also, when physicians hand out opioid medications, patients might conclude that taking them is safe. A physician writing a prescription validates the act of taking drugs. It removes the stigma, removes the sin and makes it a part of normal everyday life.

And then there is the culture. Our culture holds it as an article of faith that there is a pill for whatever that ails you. We live in a culture that has a pill for every pain, whether physical or mental.

As a nation we are suffering from what they used to call the sin of sloth.

Sometimes we call it leisure; sometimes we call it laziness.  We believe that we have a god-given right to benefit the most from from the least effort.

If a patient suffering from depression is given a choice between managing his condition by engaging in regular aerobic exercise or else by taking a pill, which one will he choose?

If he takes a pill and it works for a while, he will come to believe that his problems are biochemical and there is nothing he can do beyond taking pills.

If the pills cease to work there are always other pills…

1 comment:

Kath said...

I have been prescribed narcotic pain meds from time to time. I cannot take any aspirin related medicine.
I am generally healthy but have suffered from painful maladies such as hip bursitis and kidney stones. Believe me, the narcotic pain meds were a welcome relief.
I have never come close to addiction.
The bursitis is now gone thanks to natural healing methods. Maybe because I am proactive and look for alternative remedies, I've been protected from addiction. My father was an alcoholic so I am very aware of the dangers.
Patients are trained by the medical establishment to take pills without ever finding the cause of their illness. The symptoms are at best managed but the patient is not cured.