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The winter of our discontent

The ever-increasing complexity of the US healthcare system is reflected in the voluminous barrage of state regulations severely curtailing the dispensation of synthetic opiates to patients with chronic pain patients. These recent legislative moves are a response to a relatively small number of deaths related to the overdose deaths of members of the upper echelons of society and a few high profile celebrities, as tragic as they are. However any social problem, as history has demonstrated, does not respond well to knee jerk mob like laws that instead of specifically targeting the individual perpetrators cast a wide and unwieldy net over the entire specialty of pain, with the result that doctors are now intimidated by regulatory agencies and the treatment of pain regresses 25 years.

Medicine and the human psyche constitute an infinitely complex organism with problems and solutions that are never clear-cut. The current ‘epidemic’ of heroin abuse does without question require at the very least a proposed remedial strategy that will forensically identify individuals, behaviors and events that account for the majority of the criminal acts committed. The extension of this network into the illegal medically supported prescribing of opiate medications for patients with long term chronic pain syndromes is ill conceived and without question originated in the head of an overzealous prosecutor who most likely had a family member fall prey to her disposition of addiction. I would imagine, as this as been the case throughout history, that this individual commenced a crusade against the pain medical profession without fully appreciating the decades long work that had predated this civilized manner of treating chronic pain. Instead, and all on the back of emotion and political rhetoric regulations were passed whose intention was to intimate doctors and pharmacies from dispensing these life changing medicines.

The immediate consequences of this rather draconian set of laws have been to grievously harm the patient population who has been left with inadequately treated pain overnight. This form of cessation is, in my, opinion inhumane, and should have been preceded by open forum discussion with concerned parties. That is part of the democratic process and it seems it was utterly forgotten in this case.

When one studies the long history of drug use and abuse there is a cyclical element to it sadly depending on the articular politicians calling the shots. These individuals see every opportunity as a means to further their political career and raraely give any credibility to the reasoned science and empirical evidence. America is a rather strange anomaly in the western world with its convoluted and draconian laws regarding drug use and abuse. The billions spent by previous US governments on the ‘War on Drugs’ was an utter failure as is evident by the continued and often increased use of drugs. A large part of the governmental policy stems from willful ignorance and of course the desire to fill the state coffers. The ‘War on Drugs ‘ has done neither and has in fact drained the capital reserves of the country with no realistic claim that any objective had been met. It can therefore be said that this ‘war’ was one of insanity and most likely planned over a few whiskeys around the Whitehouse dinning table. Regardless it was a social disaster and lessons were thankfully learned about the nature of drugs, man and his desire to get high.

The current state in New Jersey is pathetically like the ill conceived advances on the cartels of Colombia and Mexico, but in this case as in the two previously mentioned, there are many innocent casualties who have been living with debilitating chronic pain for decades only to be recently told by their frightened doctors that that are no longer eligible for narcotic medication and will have to find relief elsewhere. The words on this paper can do absolutely no justice to the inhumanity of suddenly stopping the medications of an opiate dependent patient for nothing more than the dictate of a beaurocrate with limited knowledge of the complex field of pain management. To prevent this situation from escalating any further it would behold these patients to organize themselves into civil action groups and make their angry voices hears in Trenton. This group of patients stands to suffer most from these crude sweeping regulations.

The other side of this coin is the increase in the use of street grade heroin, which according to many reports has tripled over the last years with numerous deaths among the young and uninitiated. As the story goes the children of parents with medications would steal them from their medication cabinets and proceed to distribute them amongst their friends at parties. This was the beginning of the end and very shortly after this sojourn into synthetic opiates these children, unable to afford the prescription medications, headed out to the street to obtain heroin. The number of admissions to drug rehabilitation units has markedly increased and the proliferation of these units has been expedited.

This is a complex issue that requires intense attention and therapy. It does not require the tone of martial law and the manner in which the us handles this social problem will reflect on its ability to act in a truly civilized manner. The one large, pink elephant sitting in this opiate filled room is the 800 lb. pharmaceutical company that has for decades gotten away with the indiscriminate dispensing of potent narcotics to doctors with expensive ads and slick presentation. One of the obvious question is why have these companies not been barred from their reckless advertising. In my opinion it is the vastly wealthy executives of these companies that should be held accountable for some of the current heroin epidemic. Now that would be American justice.

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