DOCTORS VS. DRUG WARRIORS

One egregious and less-than-publicized side of the drug war is its
interference with doctors and their ailing patients, especially those
suffering from chronic pain.

WND's "Babe in the Bunker," Barbara Simpson, wrote yesterday about a
lawsuit aimed at one Dr. Wing Chin, an internist sued by the family of
cancer patient William Bergman for not adequately treating his pain.
Bergman is now dead, but the family scored a purse of $1.5 million in
general damages.

The only reason punitive damages weren't heaped atop the judgment,
presumably, is that the doctor did not act with any malice. He was only
doing his job ­ even if inadequately.

In an age of HMO-baiting and health-care calumny, it's easy for a jury to
blame doctors or the system for their callous disregard for the welfare of
patients ­ easy, but not necessarily accurate.

As much as doctors may want to help patients, they are constricted and
constrained by narcotics laws. "The most effective analgesic drugs are
opiates," writes psychiatrist and addiction specialist Thomas Szasz,
listing morphine, heroin, dilaudid, codeine and methadone. The trouble is,
as Szasz points out, "Opiates are the most strictly controlled of our
controlled substances."

In order to prescribe opiates, which are classed as Schedule 2 drugs
(except heroin, which classed as Schedule 1 and cannot be prescribed for
any medical purpose), doctors are subject to monitoring by narcotics
officials. "The Drug Enforcement Administration," sarcastically says Szasz,
"watches doctors prescribing opiates like customs agents watch
dark-complected travelers at Kennedy Airport."

Fearing negative sanctions from drug officials, such as jail or revocation
of their licenses, doctors prescribe powerful analgesics less and less. The
result? In the words of Dr. Russell Portnoy of the Pain Center at Sloan
Kettering Memorial Hospital, "The undertreatment of pain in hospitals is
absolutely medieval."

The fear and idiocy that churns under the surface of this issue is best
seen in the recent flap about OxyContin, a synthetic opiate which debuted
in 1995 with the promise of effective pain relief for chronic sufferers.
Like any psychoactive substance, of course, some people are bound to
experiment with its less-than-medicinal qualities, which in our present
political environment is completely inexcusable and requisite of swift
action to nip its use in the bud ­ which, while apropos, is not intended as
a pun for medical-marijuana activists.

Fueled by abuse and scare stories, like that in a January 2001 issue of
Time magazine, media and law enforcement are bucking for recognition as the
latest incarnations of Eliot Ness. After publicly announcing a crackdown,
DEA is now setting its sights on "over-prescribing" physicians. As with any
painkiller, of course, dosing is relative to the pain, and since
nerve-endings tend to reside in the bodies of patients, not DEA rulebooks,
the definition of over-prescribing is more than subjective.

As Sandeep Kaushik recounts for a June 4 AlterNet article, "One doctor in
southern Virginia recently reported that 30 minutes after a visit from a
Purdue sales representative [the company which manufactures OxyContin],
local DEA agents descended on his office to question him about what the rep
had told him and whether he intended to prescribe the drug to any of his
patients."

Szasz says the necessary result of such politicking and busybody police
work from drug cops is the undermining of the doctor-patient relationship,
sharply criticizing any doctor who would "be seduced by economic and
political enticements into abandoning his role as healer and betraying his
ethical obligation to the patient (Primum non nocere! First of all, do no
harm!), and assuming instead the role of referee ­ arbitrating the conflict
between the patient who wants a powerful analgesic and the state that wants
to withhold it from him."

As a healer, the doctor's role in many cases is to mitigate and reduce
pain. The drug laws prevent this by outright prohibition (heroin cannot be
used, despite its successful use in terminal cancer cases), overarching
regulation (limiting the use and amount of certain painkillers) or
in-your-face intimidation (prosecuting doctors who violate some fungible
and subjective standard of over-prescription ­ or threatening to do so).

"Among the remedies which it has pleased the Almighty God to give to man to
relieve his sufferings," said Dr. Thomas Sydenham in 1680, "no is so
universal and so efficacious as opium."

Drug warriors apparently know better than God ­ and doctors.