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Guest column | C.D. Chamberlain

It's time to rethink attitudes about pain medications

Florida is being squeezed between for-profit pill mills serving drug-seeking patients and citizens who exist in agonizing pain because their physicians are reluctant to prescribe enough medication to permit their patients to live in comfort.

Meanwhile, politicians who lack expertise in either pharmacology or psychology seek to exploit this tragedy for political gain.

Florida loses seven people each day from the misuse of prescription drugs. Even one needless death is a tragedy. What is to be done?

For one thing, we could re-examine the flawed public policy that some drugs are bad because they are highly addictive, and other drugs (alcohol and nicotine) are acceptable because they are less addictive. Current research indicates that all are equally addictive.

The end stage of chronic obstructive pulmonary disease is equally unpleasant, whether one used tobacco or pot. Some people can use substances for years and never become abusers or addicts; other people are adversely affected by small amounts of the same substances. Substance abuse is not due to exogenous factors (outside the body) but endogenous factors (inside the body). Denied one substance, addictive persons merely seek another self-destructive drug.

This insight is particularly important for pain management. My late wife was, for years, an intensive care nurse. She was caring for an end-stage cancer patient. The physician wanted to limit the pain medication, lest the patient get addicted. My wife said the patient had less than two weeks to live. What difference did addiction make in this case?

Then the physician worried that increasing the medication might suppress respiration. To which my wife responded, "And how would that be an adverse reaction for this patient, who is in agony? Why not make her comfortable for her few remaining days?"

I believe the time has come to engage in a serious public discussion on the broad subject of drug experimentation and drug use, abuse, dependency and addiction. The current mind-set seems to suggest that substance abuse would disappear if we could just get rid of the drugs; however, a century-long love affair with prohibition and criminalization has not proved much of an answer.

The reason prohibition is a failure became clear to me early in my professional life, when I worked as a counselor in a Salvation Army men's social service center. People seeking to get high or wasted engage in risky, self-destructive behavior. One client drank kerosene and chased it with buttermilk. Another client, who ironically had a doctorate degree in chemistry, became deaf from abusing aspirin. He eventually died from an aspirin overdose.

Was banning kerosene and aspirin the answer? Would taking rope off the market prevent youths from seeking an auto-erotic high from near-strangulation and then accidentally dying from asphyxiation?

Promising new approaches to substance abuse are under development. With recent advancements, brain scans can now make a fairly accurate identification of addiction-prone individuals. Scientists can actually see the human brain responding to substances in such a way as to be predictive of addiction/abuse.

This kind of information means it is now possible to initiate interventions that treat people most at risk for addiction. It also means that people who are unlikely to become addicted can be administered medications at levels that are adequate to control their pain, thereby reducing the reluctance of many physicians to provide effective pain management.

It is not enjoyable burying the corpse of a handsome young man who died from an accidental overdose.

It is also difficult to counsel people who live with debilitating pain but cannot find a physician who will take the risk to prescribe enough medication to control their pain.

Current policies benefit neither people with drug-seeking addictions nor people who simply want to live a somewhat normal life without crippling pain. Rethinking the whole drug issue can provide justice and mercy for all.

C.D. Chamberlain lives in Spring Hill.

It's time to rethink attitudes about pain medications 02/22/11 [Last modified: Tuesday, February 22, 2011 7:47pm]

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