THE WAR ON DRUGS A WAR ON SICK PEOPLE AND DOCTORS

"Many doctors know little about pain control and even fewer prescribe
adequate doses of necessary pain relievers..."

Drug Policy Reformers come from many different backgrounds but share
the idea that the War on Drugs is a huge failure and causes
irreparable damage both within and outside of our national borders.

The WoD has a serious and potentially deleterious impact on every
American because it directly restricts your physician's ability to
provide pain and symptom relief. Perhaps your family members have had
difficulty obtaining pain relief for chronic illnesses; or someone you
know has had problems obtaining relief at the end of life. Millions of
Americans have had such problems, it's a possibility for any of us.
The potential victims of the U.S. government's WoD include every
American who seeks medical care. The Narc and the MD When I received
my license to practice medicine from the Oregon Board of Medical
Examiners (BME), I was told that I could lose my license if I was "too
generous" with controlled drugs. The BME then explained to me how to
practice "politically correct" medicine. Naturally, the question
arises: who determines what "politically correct" medicine is? The
answer: the federal Drug Enforcement Administration (DEA), a law
enforcement bureaucracy in Washington DC.

If you can visualize a policeman in Washington DC determining how much
morphine your grandmother with cancer should get, then you can
understand what has always plagued me in my profession. When it comes
to prescribing controlled drugs, the cops at the DEA have the final
word.

The effect is chilling. It makes scientific literature, the experience
and training of a doctor, and the predicament of the patient all irrelevant.

After a few years in practice, it was impossible to avoid knowing
doctors who had been "busted" by the BME for prescribing opioid drugs
like codeine, morphine, and synthetic derivatives. Patients with
chronic pain were to be avoided like the plague and were often
referred from one doctor to another to try to stay ahead of the
threatening letters from the BME.

Doctors who read the science and pay attention to outcomes know that
prescribing opioids to patients in pain rarely leads to substance
abuse. Unfortunately such doctors are not "politically correct." At
one continuing education conference I attended, a DEA agent warned
doctors not to prescribe more than six weeks of any controlled drugs,
regardless of the predicament of the patient. But we all know that
people in chronic pain generally suffer for more that six weeks. What
are we supposed to do?

The answer from the "experts" is mind-boggling. We're told there is
really no such thing as chronic pain. That is an outrageous statement
on the face of it, and our patients tell us differently.

This is the paradox faced by doctors across this nation. We are told
to pay attention to what bureaucrats and enforcers have to say, not to
our patients. It's bizarre. What's wrong with providing pain relief
and improved quality of life when there is no chance of substance
abuse? The result of these policies is that patients live and die in
pain and doctors are too frightened to help, except possibly in the
terminal phase of illness.

Public Response to Repression As repression often does, the climate of
fear fostered by the WoD elicited a patient revolution that continues
to evolve. In 1994 Oregon voters passed Measure 16, the Death With
Dignity Act, to allow mentally competent, terminally ill Oregonians to
choose to hasten an inevitable death. This was an indictment of the
very poor end-of-life care that dying patients routinely receive. Many
doctors know little about pain control and even fewer prescribe
adequate doses of necessary pain relievers--even at the end of life.
Therefore, patients have sought to remove these decisions from the
politically-tied hands of reluctant doctors, and placed the decision
directly into the hands of the patient.

One year later, in 1995, the very important Oregon Intractable Pain
Act became law. It provided sanctuary from the BME (our "proxy DEA"),
allowing doctors to prescribe necessary intensive and long-term pain
control if the patient signed an informed consent form.

Being Politically Incorrect In 1996 the complications of a blood clot
ended my career in the private practice of internal medicine. It is
life-changing to lose a practice, but one can find opportunity in
crisis. I now enjoy doing volunteer work and am happy to no longer
have to foster a relationship with the DEA and the BME in order to
make a living. I can now be "politically incorrect" by speaking out
about how the WoD hurts patients and doctors. Speaking out before
would have meant risking my Oregon license to practice medicine, and
my federal license to prescribe controlled drugs.

One of my first goals was to preserve the Oregon Death With Dignity
Act by being a spokesperson for the 1997 "No on 51" campaign (51 was
the attempted legislative repeal of Measure 16--our Oregon Death With
Dignity Act). It is my opinion that the crucial part of Measure 16 is
the provision which puts choice into the hands of the patient. This is
why I oppose euthanasia but support physician aid in dying. The
important difference here is that the patient is in control and must
self-administer the barbiturate under Measure 16.

One consequence of Measure 16's passage in 1994 was to dramatically
spotlight end-of-life care in Oregon. In effect, it turned the tables
on the old paradigm. Not only did it suddenly become politically safe
to administer generous pain medications, but to opponents of Measure
16 it became politically necessary to prescribe. Either way, patients
have been the winners because Oregon now consistently leads the
country in morphine prescribing (milligrams per person), and in
percentage of hospice referrals. Additionally, Oregon has one of the
lowest Medicare hospital death rates--i.e. folks die at home with
family and hospice instead of in the hospital surrounded by machines
and strangers.

Unfortunately, these gains are in political peril. As I write this,
Republican US Senators (including Oregon's own Gordon Smith) are
attempting to pass a bill, misleadingly called the Pain Relief
Promotion Act, to undo the Death With Dignity Act that Oregon voters
passed twice.

Oregon Medical Marijuana Act In 1997, a legislator from SE Portland,
George Eighmey, tried to get a hearing on a potential Oregon Medical
Marijuana Act but was denied the opportunity by Republican committee
chair John Minnis. Once again, the legislature had failed and, once
again, a voter initiative became necessary. In the course of doing a
great deal of research on the subject (culminating in my co-authoring
a book about medical marijuana), I visited patients in their homes and
listened to stories about the medical use of marijuana. The research
reminded me of cancer patients I'd met in my training and practice who
informed me that they were using marijuana during chemotherapy to
control nausea, pain and spasticity from nerve damage. The inescapable
conclusion of my research was that, once again, federal propaganda was
ignoring science while interfering with efforts to provide pain and
symptom control.

My hope was that the Oregon Medical Marijuana Act would focus
attention on persons who were chronically ill, as the Death With
Dignity Act campaign had focused attention on end-of-life care.

The 1998 campaign for Medical Marijuana was intense. As a
spokesperson, I had to publicly face a "hired gun" (a former AMA
president) sent by the corporate pharmaceutical industry, as well as
argue against opponents such as Senator Gordon Smith, Multnomah County
Sheriff Dan Noelle, and numerous law enforcement officers who
predicted the end of America if our law passed. Vigorous opposition
also included the American Cancer Society, doctors from Oregon Health
Sciences University, VIPs in the Oregon Medical Association, the BME,
and other guardians of the status quo.

After a brutal and exhausting campaign, Oregon voters did indeed pass
the Oregon Medical Marijuana Act (OMMA). Yet in spite of that,
lawmakers like Kevin Mannix (running for Attorney General this fall)
introduced legislation during the 1999 legislative session that became
law and took away some of the voter approved gains from the OMMA.

The OMMA modified Oregon criminal law so that a person who follows the
law can use the herb, Cannabis (marijuana), as medicine under the
guidance of his/her doctor. Currently, over 800 patients, 400
caregivers (growers), and 400 doctors participate in the OMMA. The
Oregon Health Division has a website that describes the program
(www.ohd.hr.state.or.us/hclc/mm/).

The OMMA can only provide an exclusion to state law and cannot impact
federal law concerning distribution of marijuana to sick persons.
Therefore, in spite of scientific evidence in support of marijuana as
medicine (see www.teleport.com/~omr), we still have some obstacles to
overcome before this important, ancient, herbal medicine is truly
accessible to patients.

Health care decisions are personal, and confidential and should be
made by the patient and a chosen personal physician. This means that a
patient should not be a victim of decision-making by the for-profit
insurance industry, by self-righteous self-appointed dogmatic
religious representatives, and/or by the political morality cops. The
BME should protect patients from unsafe doctors rather than
sanctioning doctors for providing legitimate medical relief.

There is one recent bright note in all of this: Recently a doctor was
sanctioned by the BME in Southern Oregon for failing to give adequate
pain and symptom control to dying patients. (This is the first and
only time in U.S. history that such a discipline has been meted out to
a doctor, so it is too early to call this a trend.)

Victories Against the WoD Consumer/patient pressure is what is driving
the improvement in pain and symptom control in Oregon.

The Oregon Death With Dignity Act forced us to look at quality of care
of terminally ill Oregonians. The Oregon Medical Marijuana Act is
forcing us to look at quality of pain and symptom care in chronically
and terminally ill Oregonians. Now the BME (in the past considered the
right arm of the DEA in opposing opioid prescriptions and the OMMA)
has finally recognized that under-treatment of pain and suffering is
also bad medicine. The cumulative impact of these recent developments
may be to improve the medical climate for prescribing controlled drugs
under the protection of the Oregon Intractable Pain Law. As the
medical climate warms to this more enlightened approach, prescription
of controlled drugs can reflect good science and compassion instead of
the misguided War on Drugs.

Who is a drug policy reformer? Is it the college student who is
horrified that he/she can't qualify for student loans because they got
caught with Cannabis instead of "just alcohol?" Is it the libertarian
who rightfully questions the ethics of a government that passes
prohibition laws to criminalize what one puts into their own body? Is
it the agnostic who questions why religious dogma should replace our
US Constitution when it comes to personal freedoms? Or is it the
person who visits the doctor with grandma and wonders why doctors
don't "do something" when it comes to treating grandma's arthritis or
her cancer pain?

It is all of the above. No American can escape the tragedy of our
country's failed drug policy. America's War on Drugs is a war on the
American people and their doctors. Join the drug policy reform
movement because you care about others; because you care about our
society; and because you care about your rights and future needs as a
healthcare consumer.

Richard "Rick" Bayer, MD, FACP lives in Portland, Oregon, is
board-certified in internal medicine and a fellow in the American
College of Physicians - American Society of Internal Medicine. He was
in the solo private practice of internal medicine in Lake Oswego,
Oregon from 1981-1996. He was a spokesperson for "NO on 51" to
preserve the Oregon Death With Dignity Act in 1997 and was a chief
petitioner for the "YES on 67" (Oregon Medical Marijuana Act) in 1998.
He is a co-author of "Is Marijuana the Right Medicine For You? A
Factual Guide to Medical Uses of Marijuana" (Keats 1998). He currently
works with two non-profit organizations, the Multnomah County Health
Department, and the Oregon Health Division to prevent childhood lead
poisoning in Oregon.