Friday, January 4, 2019

The War on Drugs and the persistence of pain

There's quite a discussion going on in the comments of the posts here and here.  A really good insight was left in this comment by Bill AKA waepnedmann:
I noticed that the three commenters, Aesop, Peter, and myself, who were relegated to the pro-war on drugs camp have their opinions formed by having been in the trenches on this so-called war. 
Aesop on the front lines in an ER 
I have a step-son who retired out as a paramedic in Richmond, CA. 
You literally cannot conceive of what medical personnel not only witness, but with which they live and wake up to in their dreams. 
PTSD is not only found in soldiers.  
Peter as a prison Chaplin. 
Myself: Twice my employment involved drug users and they damage they do: once as an MP in the Army (I was actually the NCOIC acting, for two months, at the maximum security cell bloc for an area confinement facility. Some of the troops returning stateside from The Land of Bad Things had drug problems and drug problems morphed into behavioral problems.
These guys speak passionately about their experiences dealing with people who are destroying their own lives, or the lives of others.  They speak passionately because of what they've seen.

I'm also going to speak passionately for a moment, about something that effects my life.  The Queen Of The World has had problems with her knees, problems that have been going on for a couple years now and which had her on crutches for months at a time.  Her doctors won't prescribe her pain medications because of the restrictions that they're under from the War On Drugs.

It's something to have to see the pain in her eyes day in and day out.  She's quite a trooper, but I can tell that it wears her down - the months and years of chronic pain take their toll.

To the people that think that the War on Drugs needs to get dialed up to 11, that there needs to be even more of what we've been doing - that we need to do it harder - well, she is the collateral damage from the stupid war.

Your point is a good one that people destroy their lives using drugs, but it's them who do it to themselves.  It's them that cause the aggravation and pain to their family and neighbors.  It's they who are not - and never will be - perfectible, or possibly improvable because they don't want to be.

But it's the government that is forcing the Queen Of The World and millions of others to remain in chronic, unrelieved pain for months or years at a time.  Remember, they say that government is just the things that we choose to do together.

This is personal to me.  Come up with a way to fight the War on Drugs that doesn't burn down the village to save it, or declare victory and go home.  I don't think that there's a way to win without massive collateral damage because the people using drugs want to use them, they don't want to stop, and they won't cooperate with efforts to improve/perfect/save them.

Out of the crooked timber that is Man nothing straight was ever built, and all that.

But it's not cool to keep the Queen Of The World and all the legions like her in constant pain.  It's not cool for local police departments to get all ninja'ed up.  It's not cool for no-knock drug raids to go into the wrong house by mistake.  It's not cool for law enforcement to get corrupted by bribes (or intimidation) from the cartels.

But there's no reforming a system this big.  Bureaucracies gonna bureaucracy and while the people in the system mean well, the system is lousy and getting lousier.  Out of the crooked timber that is Man nothing straight was ever built, and all that.

I do not believe in the perfectibility of mankind, and I sure as hell don't believe in the perfectibility of large organizations.  To win the War on Drugs you need both.  Or you need the organizations so strong and brutal that the population is cowed into acting like they have been perfected.

No thanks.  The Queen Of The World doesn't deserve this: she's the nicest person I know.  The millions of other people that the government keeps in pain don't deserve it either.  The human cost of the War On Drugs is not sustainable, it's not justified, and it needs to end.


ASM826 said...

哦 哇 所以 许多 失败

It's civil forfeiture without trial and conviction, no knock raids, military tactics, show of force response. This is the price of the War on Drugs. And it's unsustainable. It makes the police into an occupying force, not protecting & serving, but controlling & subduing.

The Republic can and will survive drug addicts and alcoholics. It can not survive a police force that has been been turned into a military force. Because once you have that force, you use it all the time.

And the War on Terror just turns it all up to 11.

RCODE3 said...

Bingo! Nobody is saying that drugs are good. We all know that people end up abusing themselves, and unfortunately sometimes their children. But the collateral damage from the War on Drugs is just too high.

Pachydermis2 said...

From my perspective (retired MD) there is not that much overlap between the two issues under discussion. Sure, in my days working in the trenches of the ER we saw a fair number of straight up drug seekers but that's a niche problem.

Whether and which drugs should be legal is a really complicated issue with lots of (probably) unforeseen consequences. It deserves if seldom receives a wide audience and lots of input.

The issue of how to best control chronic pain is an entirely different one. Long term use of narcotics is so fraught with problems that it should be the last, not the first, resort. They are of course superb for short term pain relief or even intermediate use such as terminal disease.

I never "practiced" over the internet but for a lot of knee pain the solution actually is joint replacement. It works very well if the issue is just plain wore out parts.

I could go on at length but just with regard to the small but problematic group of straight up drug seekers in the ER, the issue there is not so much that they are damaging their own health, but by diverting time and resources are damaging the health of others in a situation where said resources, especially time, are finite.

Glad to be out. I don't ever have more than passing nostalgia for my earlier career.


waepnedmann said...

I think there has been a misunderstanding regarding my stand on the war on some drugs.
The war on drugs as we are now prosecuting it is a losing strategy.
As long as there is a demand for illegal drugs it will be met with all that entails including gangs, cartels, and corruption of law enforcement and politicians.
IF (big if) we as a society would decriminalize drugs it would eliminate a myriad of ills overnight.
We will not do that because there I'd too much money involved.

Drugs as medications are a different issue.
The opioid crisis is a manufactured emergency.
I refer you to Aesop's and SiG for the numbers and why I make that statement.
Aesop is strongly opinionated and can be, and usually is, quite abrasive, but he has good numbers supporting that the opioid crisis is all about the money. SiG traces this "crisis" to coffers of the Clinton Foundation.
It is worth the time to educate yourself as to why we are in this crisis.
Prepare yourself for anger kin to the Heat of a thousand burning suns.

I not only sympathize with TQOTW, but genuinely and literally feel her pain.
In the last seven years I have had six surgeries on my knees including the first total knee that the surgeon massively screwed up and kept telling me to do more therapy and give it more time.
Oh. And pain meds? None for you!
There is a great temptation to document the odyssey of pain that has brought me to my third total knee (with a different type of appliance this time!) next month.
At this point I could not function to any degree of normality without pain meds.
I would be crippled mentally and physically by the pain.
If the doctors could give me pain meds in sufficient quantities to continue to function without another knee replacement that is an option I would take.
I have some formal training through my past work in opioid addiction and know the long term effects of opioids use.
I am willing to make that trade off to be out of pain.
This is not an option because .gov ties the hands of the physicians. They are frustrated and angry.
Not only does .gov tie their hands, but some corporate pharmacies also tie the doctor's hands by limiting the amount of meds for which they will fill a prescription.

I am angry, because I know that the elites do not have to deal with the pain that we have to endure due to their greed for power and money.

I have a history of pain going back to my childhood. I have a few years left in this life and would prefer not to exist the rest of those years dehabilitated due to pain that is preventable.

We have been talking apples and oranges.
Medication vs getting high.
Some people would say getting high is a way of dealing with their pain. I have no input on that argument.

TQOTW has my sympathy and my respect for enduring.
There have been occasions on my odyssey that with no end of pain in sight I have found myself mulling over Hamlet's soliloquy.
But, I have promises to keep.

pigpen51 said...

I hesitate to weigh in on this topic, as I have a horse in the race, and it will come across as only self serving. But that doesn't stop me from voicing my own opinion, it just serves as a caveat for those who are on the other side.
I am a chronic pain patient, who is on permanent disability from my pain. I get chronic, near daily migraines, plus a damaged back from a car accident in my youth, and 35 years of labor in a foundry. I have searched for my entire life for a treatment plan to control my migraines, with no success. I have tried any of the possible treatments that most everyone has an opinion about, and feels the need to share with me, since " it worked for my friend."
I have been to literally dozens of different doctors and neurologists, headache clinics, state university, etc. I never stop trying to find a cure of some type. I am currently trying the newest class of drugs, an anti CGRP drug called Aimovig. So far, after over a month, I have not had any results, but it can take some time for it to work, and so I continue on.
The only thing that I have found over the years, to help during an attack, is a narcotic and an anti nausea medication. With this combination, I usually can get to sleep, and have my headache gone when I awake. Of course, we know that doctors are ever more unwilling to prescribe pain medication for chronic pain patients, but instead push other, less effective means of controlling pain. What it mostly boils down to is to just suffer and learn to deal with pain.
Like your wife, Borepatch, I get weighed down with having not only to deal with pain, but with judgemental people who might mean well, but only see things through the lens of their own experience, and don't have to suffer the reality of pain. Instead, if you try to explain that you are in pain, and do need narcotic pain control, you are looked at as a drug abuser.
If we looked at another symptom of the disease that one might have, in addition to pain, would we look at treatments in a different way? If a person had a disease like Parkinson's or some other disease, and it needed both a primary drug therapy, plus pain control, would we say that we will treat all of your symptoms, except for pain? For pain, you have to learn to deal with it.
While this is a tough issue, it cannot be swept under the rug, or glibly treated as just an addiction issue. Doing anything except seek treatments that work for pain patients is just not acceptable to too many people, on both sides of this issue.

LindaG said...

Just like guns. Bad people make it worse for law abiding people.

Aesop said...

Got it.

We should just want to get rid of the War On Drugs, but turn the collateral damage up to 11.
Or 42.
Because reasons.

Because it's imagined that legalizing drugs will magically mean that Rx scrips are suddenly going to be loosened.

Instead of, say, tightening the screws on abusers, while loosening exactly the jackassical crackdowns on actual patients receiving medication for medical conditions, under the care of licensed professionals, and subject to regular and strict monitoring. IOW, the easiest problem to solve with the least adverse outcome for anyone.
Because why would we want to do something sensible and simple when we can fornicate the whole country up at a few penstrokes?

So now we should push the entire society off the cliff to get some people what they want. Because all the other people directly affected are not them, nor their kin...

It predates the current discussion here, but I've already hammered on the stupid aspects of misregulating and misdirecting things, a time or five.

You'll even like it, Borepatch, because Pt. I kicks off with another example from James Burke and The Day The universe Changed.

A relevant excerpt from Pt. II:

"If anything, the "explosion" of opioid scrips isn't due to granny and grandpa getting high, it's simply the Law of Unintended Consequences kicking the ass of twenty- and thirty-somethings who couldn't pass a grade school long division quiz from 1960.

Because the DEA, the CDC, and idiots in state government here have been cracking down on prescriptions for pain killers. Precisely because of young doper drug-seeking assholes who aren't getting them anymore, as the bar graph above documents. How does that work? Thanks for asking.

Doc Friendly in BFCalifornia used to write Old Man Johnson, busted up ten different ways from 50 years of working with farm equipment, dumbass cattle, or ornery stands of timber, a scrip for 90 days' worth of Vicodin/Norco, so he'd get four scrips a year. If the Doc does that now, the DEA crawls up his ass, and threatens to revoke his federal license to dispense.

Medicine has two names for Doc Friendly, and every other doctor, who can no longer write prescriptions (that would be "deliver proper standard of medical care") to his patients:
If he's well-off enough, and tired of that BS, the AMA and state Medical Board call him a "retiree".
If he's young, and still trying to pay off his hundreds of thousands of dollars of medical education debt, they call him a "barrista".
With or without a shot of whipped cream.

So instead of a ninety-day supply of meds for chronic pain, he makes Old Man Johnson come in 12 to 52 times a year, and gives him a scrip for a month (frowned on) or even just a week. So now he generates 52 scrips a year for what used to be 4. Johnson now has more prescriptions, by himself, than 52 other people who never need a single one. And if he's really, really fortunate, he won't have to decide between feeling unspeakable agony as his bones grate on themselves every day, or feeding himself and his sick wife this month."

I repeat for emphasis -"almost like I work in the field, and know WTH I'm talking about."

waepnedmann said...

I noted that the physicians hands are tied by .gov regarding opiotes as pain meds.
Over the last year I have listened to a surgeon, a GP, and two PAs opine that the consequences, unintended or not, of tightening opiate use will be an increase in alcohol abuse and illicit drug use.
A grim prophesy.

Aesop is right about the busted up old folks.
There are a lot of us out there.
The interesting times of our youth have come demanding payment, but not all of those interesting times were a result of being unable to do long division.

Beans said...

What you all said and more.

Chronic and actual needs users that are correctly prescribed legitimate drugs are equivalent to the average not-rich-as-Croesus gun owner who is caught in the crack of Gun Control Legislation. Here me out.

Supposedly, GCL is supposed to stop crime, make the world safer, cause rainbow unicorn farts to power bird-killing fans of doom and all that. But what gets legislated is harsher and more onerous controls on legal gun owners, making them illegal.

So here we are in the War on (illegal use of) Drugs (and illegal drugs) and who is most affected? The person on disability who needs their daily doses of morphine (extended release and immediate release for breakthrough pain,) Lyrica, Gabapentin, and all those good drugs. So they have to cough out the cost of the doctor visit monthly and then the monthly drugs. Why? Because... arseholes are illegally using drugs of this style by getting them illegally. So the legal drug user has to jump through 50,000 stages of regulations to get their pittance, but the illegal dude gets free treatment, free supplies, a helping hand in and out, free medical whenever they overdose and...

My wife, who suffers from chronic pain from way too many bad things happening, has a nerve stimulator, is on a handful of pills, has trouble with the lousy roads in this town, but monthly has to go and see her pain doctor and get the same scrips over and over. Every 3-6 months she's subject to a random drug test because DEA is up the arse of her pain management doctor because of jerks in South Florida. We also legally can't fill one of those prescription minder sorter bin thingies because it's illegal to have your opiates and other schedule II drugs not in their pill bottles. We can't take the 3 or 4 pills left in the old bottle and pour them in the new bottle thus increasing the pill count past the number on the bottle. We, if stopped, have to justify the levels left in each bottle of controlled substance, else we're subject to arrest for illegal use. Notice I say 'we' a lot? Well, I'm the one who goes and gets the drugs. I'm the one who helps her dispense her meds. I'm the one who pays for them. So if she gets popped by some jackarse for correctly using her legal drugs, then I can also be sucked into the rathole of prosecution.


Punish the bad people. Who do bad things. Quit punishing the good people who actually need medications.

Patrick Henry, the 2nd said...

My wife went through the same thing. She had an outpatient surgery, and when she got home, she started having spasms. And on a fresh surgery spasms are painful. Took an ambulance to the ER. The first nurse refused to give her any pain meds despite the fact that she was SCREAMING in pain. All the nurse did was close the door so as not to hear it. Why? Because she thought my wife was a drug addict. You can’t imagine the helpfulness and the rage at watching someone you love be in extreme pain, and the people are are there to help care more about someone abusing it than actually helping stop the pain.

All of you for the War on Drugs talk about the pain drug use causes to others, but you ignore all the pain restricting drugs causes to others. And not just forcing people to suffer because “somebody might abuse it,” like the nurse did to my wife. But all lives hurt and lost due to police activity- shooting first in traffic stops and raids, asset forfeiture, and jail time- due to the War on Drugs.

And its funny- the people like Aesop who’s is on the front lines prove our point, yet they don’t realize it. Despite all we have done, all the bad laws restricting liberty, all the money we have dumped into the fight, all the lives hurt and lost as side effects- they still see the terribleness of drug use. Yet they don’t realize that many of that is due to all we have done. Can it really get worse? Really? And is it really worth it? Is it worth innocent people being harmed by the state or doctors or nurses, because messed up person wants to get their jolly’s off? Really?

The answer is no, no its not. It’s not worth it. It won’t get worse. In fact it will get better.

We’ve tried it your way for 50 years. It’s time to try it a different way.

Borepatch said...

Tim, I'd like to see doctors and patients be able to decide the risks and benefits on their own.

Aesop, I'm living with collateral damage right now, and it really pisses me off. TQOTW and her doctor should be the ones discussing what damage is possible and whether it's worth it or not. Everyone else can STFU and sit down (with my compliments). What you and yours want to do with your own pain treatment is none of my business and I'll keep my nose out of yours.

To everyone who posted about their own dealings with this massive government SNAFU, thanks. I'm sorry to hear that there are so many of us.

Borepatch said...

Aesop, that James Burke episode was pretty awesome. Your point of keeping track of what works and adjusting accordingly is a good one. The current restrictions in the War On Drugs could use a healthy dose of that.

pigpen51 said...

So Aesop is fine with our country imprisoning more people per capita than any other nation on earth. Especially since a large percentage of the inmates are non violent, and just victims of the war on drugs. Even the ones in prison for stealing to feed their habit, could stay free, provided that they were able to obtain narcotic medication at a cheaper price.
I believe that I once read that heroin is relatively inexpensive to refine. The only reason that it is so expensive that it forces those who use it to steal, is due to the fact that it has been made illicit because of the war on drugs.
This issue is not going away, no matter how much the people who want more drug control scream and stick their head in the sand.

Beans said...

pigpen51. Trust me. I've dealt with the drug diversion 'patients' who have committed horrible crimes in order to get their stuff, and the 'normal' drug diversion patients who 'just used for personal reasons.' There's not that much difference between the two.

Decriminalizing drug crimes? So, well, let's decriminalize or at least reduce the sentence of 2nd or less murderers. That way some of the most expensive prisoners won't be in prison.

Heck, let's just let them all out. There's no reason to punish people at all for any crime they commit, either civil crimes or well, crime crimes. That way no-one is imprisoned and we'll be a bright shiny society, the envy of all. After all, decriminalizing crimes has worked for California, no?

As to heroin, yes, it is inexpensive to refine and produce. So are diamonds. So what. Both are deadly and cause huge problems in the world... No, seriously, cocaine is easy and cheap to produce. So are most drugs. Cheap and easy to produce where labor is cheap or expendable. Cheap where no worries about environmental hazards and pollutants are a problem. Cheap where life overall is cheap. To refine heroin, or cocaine or amphetamines or fentanyl to where the drugs are safe for the workers, for the environment and for the user (no nasty impurities and such) and pays the laborers a decent wage does cost a lot more. But, well, if you want cheap heroin vs expensive morphine, go ahead and support some terrorist run drug cartel, or if you want your amphetamines cheap, go ahead and get that Mex Cartel meth. Good comes expensive. Good requires clean facilities and constant testing and a poop-load of lawyers in case the company's products starts killing people.

Now that's a thought. Start holding the cartels to the same standard litigiously as the drug companies. Exactly how many overdoses and side effects are related to the dealers and the cartels not using clean equipment, clean precursors, safe environments... After all, Cartels are just international pharmaceutical corporations with uglier and scarier drug reps...

Ed Bonderenka said...

Do we go back to cocaine in Coca-Cola?
Various brands of opium hawked on TV?
I can't see why you can't have a WOD and still supply meds people need.
I realize the problem exists that you describe, but there's a baby and there's bath water.

Pachydermis2 said...


A touchy subject for sure. When I say Last Resort instead of First I don't exclude any option.

It is hard to have those conversations with anything like accurate foresight. Doctors are fallible. Patients are fallible. I've seen too many things go badly wrong.


Glen Filthie said...

I'd like to publicly re-affirm my allegiance and loyalty to The Queen and her vassals and servants, BP and ASM.

But with respect, I don't think anyone is saying that The Queen or any of our esteemed elders should suffer. Nor do I think it honest to present this as an 'either/or' thing. Even an incompetent judiciary like ours should be able to distinguish a turd brained drug addict from a good honest woman in pain. If they cannot - then it is time to hang judges from lamp posts, not indulge and enable drug addicts.

I think the situation involving our Queen is the product of the so-called 'Opiod Crisis'. That is a different can of worms altogether, and is no grounds for gutting our already lame illegal drug laws.

Differ said...

The WOD is clearly not working; it's direct, indirect and unintended consequences are destroying liberty and lives.
Would a Laffer curve apply?
Left side, no drug regulations at all, full liberty, but with plenty of adverse consequences as pointed out by Aesop et al. Right side, total state control, prohibition, regulation, etc.
Right now I'd say we're close to the right side and the effects are bad.
What us the least adverse condition somewhere in the middle?
A real broad analysis of costs/benefits might shed light on the right dividing line between legal and illegal drugs, treatment of chronic drug abusers vs users of pain meds for chronic pain etc.
At least we need to dial back the WOD, starting with prescription meds.

Richard said...

I am sorry that people screw up their lives (and those of their loved ones) with drugs. But I am outraged that other people are denied the pain relief they need to function.

I sort of have a dog in this fight as I have chronic pain from arthritis and a severe injury. It does drain your energy away. Fortunately, while chronic, my pain is not severe enough to require high end painkillers. But I have had episodes of severe pain, mostly associated with surgery where I have been prescribed opiods and have needed them. If my chronic pain were to rise to this level, I would have a problem like others have mentioned. I will note that I get absolutely no high from the drugs only pain relief. Obviously, recreational users do get a high or they wouldn't do it. Don't know whether this is personality or some sort of physiological difference. The people caught in the middle are the ones that need the drugs on a regular basis for medical reasons. I have absolutely no problem saying that one person like this is worth 100 cases of collateral damage from recreational users. I suppose there is another category of people who have a medical need but accidentally become dependent. This seems like a medical issue and someone more competent than I can comment on this.

pigpen51 said...

I certainly acknowledge that there are some criminals who are caught in the web of the war on drugs. And I am not advocating that we not punish criminals. What I am saying is that we should stop the war on people who commit a victimless crime. By that, I mean that the only crime that they have committed is against themselves.
It is a somewhat Libertarian argument that says that what I do with or to my body is no business of the government, as long as I do not hurt anyone. The Libertarians would include not only the made up crime of abusing drugs, but also the crime of prostitution. The argument goes that what a person does to themselves is their business.
What has happened is that the government has made up laws that punish someone for the crime of doing what they want, so long as they do no harm to another. The argument could be made that the recent bump stock ban is a made up crime that hurts only the law abiding. And it creates hundreds of thousands of criminals, who have done nothing to hurt anyone.
By saying that why not just eliminate all laws, you are just making a straw argument to argue against people having freedom. In our country, we have so many laws that if the law enforcement side decided that they wanted to arrest someone, they could certainly find a law that the person had violated, just out of ignorance of that law. While it is said that ignorance of the law is no excuse, in fact, it should be an excuse. Laws should be based on common sense, so that they are actually not needed. I mean, do we really need a law to tell us that murder is wrong? It is when a law is based not on common sense, but rather on some politicians idea, in order to control people that we get into the danger zone. And it is those laws that are used against normally law abiding people, making them into scofflaws with no real reason save to make the government more powerful.

Ruth said...

I don't pretend to have studied the problem. I haven't, I know it.

But when I go into my doctor, and tell him that at the end of my day my feet and ankles hurt so by god bad that after I drive home and open my car door, I CRY, because I know that walking from my car to my house is going to be agony, and his response is to tell me to take tylenol and walk out of the room and refuse to discuss it further. I can tell you that the current set of solutions isn't working. I was not, and am not, on narcotic pain medication. I was not, and am not, on anything stronger than the max prescription dose of Mobic. I wouldn't have taken narcotics if he'd prescribed them.

You know what fixed my feet/ankle problem? NEW NON-STANDARD INSOLES FOR MY SHOES. That was all it turned out I needed. But it took another 6 months of crying at the end of my day while I worked my way through the system of getting another doctor and the referrals that I needed, to get them.

The current war on drugs isn't fixing the problem, and its causing more problems. I don't pretend to know what the right solution is. But the current one isn't even kinda working.