Pain Control and the Law
It can be easy for modern folks to forget how recently medicine has been able to provide relief for serious pain. Yes, the ancient Greeks had aspirin - willow bark - but until narcotics, derived from the poppy, arrived, and ether, for surgical procedures, physicians could not offer much for pain, which may be the most common complaint of patients. A nice summary of the history of pain treatment here.
We distinquish chronic from acute pain. With acute pain, of course, we try to identify the cause and to fix it. For chronic pain, where we know the cause, for example, cancer, arthritis, back problems, and a vast variety of others, narcotics often end up being the only thing we have to offer. Sure, we send patients to pain clinics, neurologists, acupuncturists, etc., but narcotics are what we use when all else fails. They work, they are not evil, and they are a blessing to mankind. And yes, they are addictive or at least habit-forming, but with chronic pain or terminal cancer pain, you don't worry about that. Why would it matter?
What bothers me is when law-enforcement begins to worry about doctor prescribing, but I always figure it's a lot easier for them to go after docs than after drug dealers with 9 mm handguns, vast networks, street smarts, secrecy, etc. With docs, you just walk into their office with pharmacy records. Easy, but accomplishes nothing worthwhile. There may actually be MDs out there who prescribe narcotics in a criminal fashion, but they are so few as to be of no significance, while illegal drug-dealing is a billions-of-dollars business in the US. Not to excuse them, but it isn't exactly a major American crisis. All docs get pretty good, but never perfect, at discriminating drug-seekers from pain patients.
When, as is known to happen, patients with narcotics prescriptions sell or otherwise distribute their pills to others, it's not the doc's responsibility and it's not his doing. John Tierney in the NYT has an excellent piece on how legal intimidation can interfere with humane treatment of patients in pain, and his piece also shows how the "War on Drugs" has been totally ineffective. And when you read a case like this one featured in the current Time magazine, it breaks your heart. Any DA who thinks he's a hero for prosecuting a pain specialist is lower than whale poop. But it's much easier than going after the bad guys.
About twenty years ago, we went through one of these phases, when docs were fearful of making patients, even terminal patients, addicted. It was a silly medico-cultural fad, but it passed, and physicians resumed treating pain patients adequately. And the invention of the morphine pump has been, in recent years, a God-send. I would hate to see medicine forced back to the 1970s and 80s when docs were looking over their shoulders, worrying more about anything other than their patients' pain. And if you are a patient with pain, you will agree with that.
