An argument in favor of the DEA

[BlackShanglan]

From time to time, for reasons non-life-threatening and tedious to explain, I experience a great deal of pain concentrated into a short period of time. It's a small matter in an otherwise enjoyable life, made more bearable by the knowledge that there is no real cause for alarm. There's nothing wrong, just a malfunctioning nervous system temporarily reporting "agony" when it is in fact experiencing "mild discomfort."

That said, every time it occurs I find my thoughts wending back to the same place and point in time. It's a small room at Limerick University, some years ago when I was there for professional reasons. I had injured my back, and in that little room a kindly doctor came to visit me and get me back into shape to travel home the next day. Having only a short period of time to accomplish this, he apparently called in the heavy artillary.

I suspect it was morphine. I don't know for sure, and on the whole I am glad that I don't know. I'd never felt anything quite like it, and haven't since. I was vaguely aware that I was still in some pain, but I simply didn't care. I was washed and adrift in the most delicious feeling of peace and well-being I have ever felt. A window opened in my mind; suddenly I comprehended drug addiction in a way I never had before. What, indeed, would it be like to know that that feeling was always only a pinprick away?

It disturbs me. I experienced the sensation once, and only once - years ago. Yet when I am in pain again - at times emotional as well as physical - my mind throws the image of that room back to me, and the feeling of the bed and the cool breeze blowing the curtains by the open window, and how intensely *good* it all felt. And, admittedly, I am glad then that there are laws restricting the substance. I do not need it. Intellectually, I do not want it. And yet, if I could get it ...

Could I help myself?

Shanglan

 

[Lucifer_Carroll]

Comfortably Numb (Gilmour, Waters) 6:49
Hello?
Is there anybody in there?
Just nod if you can hear me.
Is there anyone at home?
Come on, now,
I hear you're feeling down.
Well I can ease your pain
Get you on your feet again.
Relax.
I'll need some information first.
Just the basic facts.
Can you show me where it hurts?
There is no pain you are receding
A distant ship, smoke on the horizon.
You are only coming through in waves.
Your lips move but I can't hear what you're saying.
When I was a child I had a fever
My hands felt just like two balloons.
Now I've got that feeling once again
I can't explain you would not understand
This is not how I am.
I have become comfortably numb.
O.K.
Just a little pinprick.
There'll be no more aaaaaaaaah!
But you may feel a little sick.
Can you stand up?
I do believe it's working, good.
That'll keep you going through the show
Come on it's time to go.
There is no pain you are receding
A distant ship, smoke on the horizon.
You are only coming through in waves.
Your lips move but I can't hear what you're saying.
When I was a child
I caught a fleeting glimpse
Out of the corner of my eye.
I turned to look but it was gone
I cannot put my finger on it now
The child is grown,
The dream is gone.
I have become comfortably numb.

 

[cantdog]

Your intellect is of course correct. The insight has been salutary, though. My back and hip between them make my waking sure to be an awakening to pain; I take hours, sometimes, doing the things I need to do to quieten that. I can place it under a discipline generally by early afternoon so that I can ignore it and go about my business. But I have always resisted drugs for it. Stretches and pacing, exercises of a sort bring it to heel, most days.

My wife sees many people in pain, day after day, as a nurse at the emergency room. Her experienced eye gauges their pain fairly accurately. She tells me nearly anyone with my levels of it would long since have been an addict to something. The physician I use issues a great many prescriptions for controlled substances. He would be, in fact, the preferred doc for the narcotic user.

I think about that wistfully sometimes, but I have met junkies. Crackheads can be rather fun to talk to, but junkies begin to have a common personality, resembling each other more as the lifestyle continues through the years. I don't want the alcoholic personality, and I don't want the junkie one. Methadone people, for some reason, are even less pleasant than junkies.

I do use ibuprofen preventatively before a big job like roofing or laying rug or something, and I take one before bed if we're in a hotel, because the mattresses are bound to be the wrong firmness, and the schedule is likely to be tight.

Airline seats are agony right through. But I'm not doing it. No one can "handle it," even though they all think they can. I'm only fifty, so I could inflict that personality on those I now love for decades yet. Maybe when I'm eighty-five or something.

 

[Guest]

I've sent you a dream from Oscar.

Perdita

 

[Colleen Thomas]

Personally, I have been forced to aquire pain killers through questionable intermediaries. Here in NY they have made is so hard for doctors to prescribe them they would rather see you suffer. I don't blame them. Still, you do what you have to do.

-Colly

 

[BlackShanglan]

But I'm not doing it. No one can "handle it," even though they all think they can. I'm only fifty, so I could inflict that personality on those I now love for decades yet. Maybe when I'm eighty-five or something.

Agreed. Alas, I know my own weakness; I am glad to have the help of the stuff being out of easy reach.

Perdita, my sincere thanks. Your dream was beautiful and stirring. It's the perfect reminder that there is a great deal more to life than an insipid dulling of its pain. I suppose it's all back to Wilde - everything must be paid for. To experience any of life intensely, we must experience it all intensely.

Shanglan

 

[R. Richard]

I have dealt with a great many drug users. The drug does kill their pain, but at what cost? If you had ever seen a 'shooting gallery' in an abandoned building, you would know that the cost is always too high. If you had seen young girls selling themselves for a few more hours of pain free dream and known that their lifespans were likely to be measured in a very few years, you would know that the price is too high. Finally if you were a PCP user who tried to mug me down a dark alley, you would not know much of anything.

 

[BlackShanglan]

Ah, I forgot Lucifer. That song comes to mind on a regular basis, although my mind seems to reserve it for moments of mental rather than physical anguish. This is part of what tells me that it would be very unwise to inquire too energetically into what that lovely stuff was that the doctor gave me; I am a wallower by nature, and when that mood strikes me I drink heavily and watch "The Wall" and "Trainspotting" over and over.

 

[CharleyH]

I have never been administered anything beyond a tylonol. On the other hand, recreationally . . . and yet nothing I ever did left me wonting for more. Quite literally my body reacts poorly to opiates and my mind transcends to a nightmarish state. Self-control has always played heavily - the desire to live much more incredible than walking the path to oblivious death of spirit. Though I have to admit experiencing people who have taken morphine for pain is exceptionally amusing. (not their physical pain, which surprisingly is never fully muted).

Huxley wrote a particularly incredible and vivid (if memory serves me) mescalin experience.

Agreed with Cantdog and adding that experiencing a junkie (more so than the junk) leaves you thankful for absolutely everything in your life both blissful and painful - as acute as can be.

 

[carsonshepherd]

My mom has to live on pain pills - nothing else will do it, without them she can't even walk or sit without hurting. She's only 50, so she tries to take as little as possible to take the worst edge off. I have chronic pain but it's the type a person has to live with. I'm looking into acupuncture though. 2000 years of Chinese medicine is proof enough for me.

Anyone tried acupuncture?

 

[CharleyH]

My mom has to live on pain pills - nothing else will do it, without them she can't even walk or sit without hurting. She's only 50, so she tries to take as little as possible to take the worst edge off. I have chronic pain but it's the type a person has to live with. I'm looking into acupuncture though. 2000 years of Chinese medicine is proof enough for me.

Anyone tried acupuncture?

My ex did for something temporary. Did the trick for about a week. She became addicted.

 

[matriarch]

My mom has to live on pain pills - nothing else will do it, without them she can't even walk or sit without hurting. She's only 50, so she tries to take as little as possible to take the worst edge off. I have chronic pain but it's the type a person has to live with. I'm looking into acupuncture though. 2000 years of Chinese medicine is proof enough for me.

Anyone tried acupuncture?

Not an option for someone who 'has a thing' about needles. *shudder*. Hence the lack of tattoos (something I have always wanted), and not one single piercing.

But I do know of many people who swear by it. I simply try to tolerate the pain for as long as I can until the only thing left to do is take a heavy duty pain killer and go to bed. *sigh*.

 

[dr_mabeuse]

Pain is at least 50% mental. No, this isn't going to be a mind-over-matter lecture, because I'd be the last one to argue about that, being a real baby when it comes to pain, but pain's a lot easier to handle when you know it's temporary. Chronic pain is another thing entirely, and it's really a shame the way the DEA ties physician's hands when it comes to prescribing for people who are in constant agony, simply because of the moral stigma attached to use of opiates.

But we could certainly make pain-killers more available without just throwing open the doors to the pharmacy for anyone who wants to try them. Opiate addiction is a medical problem, and it's only here in the States that we seem to treat it as a punishable crime. If it were legalized, licensed and regulated then we wouldn't have all these sordid shooting galleries and girls forced into prostitution. There's nothing inherently degrading about opiate addiction, and the fact is that there are a lot of functioning addicts (a good number of them physicians and nurses) who live productive lives despite their addiction. It's the law that makes criminals out of addicts, not the drug.

If it were legalized and regulated then those who really needed it could get it, and joy-poppers would still have a hard time getting their hands on it.\

And BS, one of the things you'd learn is that if you want to recapture the joy of that initial high, you'd have to space out your use by months or years to avoid habituation.

---dr.M.

 

[Colleen Thomas]

My mom has to live on pain pills - nothing else will do it, without them she can't even walk or sit without hurting. She's only 50, so she tries to take as little as possible to take the worst edge off. I have chronic pain but it's the type a person has to live with. I'm looking into acupuncture though. 2000 years of Chinese medicine is proof enough for me.

Anyone tried acupuncture?

I don't know what kind of pain you have Carson. I haven't tried acupuncture, but I was allowed to see a Chiropractor. She has really helped a lot, despite my initial skecpticism.

Best of luck hun.

 

[Colleen Thomas]

Pain is at least 50% mental. No, this isn't going to be a mind-over-matter lecture, because I'd be the last one to argue about that, being a real baby when it comes to pain, but pain's a lot easier to handle when you know it's temporary. Chronic pain is another thing entirely, and it's really a shame the way the DEA ties physician's hands when it comes to prescribing for people who are in constant agony, simply because of the moral stigma attached to use of opiates.

But we could certainly make pain-killers more available without just throwing open the doors to the pharmacy for anyone who wants to try them. Opiate addiction is a medical problem, and it's only here in the States that we seem to treat it as a punishable crime. If it were legalized, licensed and regulated then we wouldn't have all these sordid shooting galleries and girls forced into prostitution. There's nothing inherently degrading about opiate addiction, and the fact is that there are a lot of functioning addicts (a good number of them physicians and nurses) who live productive lives despite their addiction. It's the law that makes criminals out of addicts, not the drug.

If it were legalized and regulated then those who really needed it could get it, and joy-poppers would still have a hard time getting their hands on it.\

And BS, one of the things you'd learn is that if you want to recapture the joy of that initial high, you'd have to space out your use by months or years to avoid habituation.

---dr.M.

Here in NY my case is not unique. I have CHDS, Chronic Dialy Headache Syndrome. It's a very new diagnosis, but basically it means I suffer mirgane type pain at least 20 days out of each month. The most my regular gp can prescribe is Fiorocet. Basically a headache med with no serious pain killers. His exact words were I wish I could give you something stronger, but I could loose my liscence.

They know I am in pain. they know advil is like trying to stop a tank with a bb gun. And yet, they can't gve me anything for it, because the laws here are so restrictive and the doctors are so liable, should I become addicted, that the are prepared to let me suffer, until my quality of life devolves to the point where I think death would be far preferable.

So I go home. My gp in Ms. prescribed a muscle relaxant and Darvocet. His theory is it is better to be addicted to the muscel relaxant and functional, than clean and dsober and in pain that keeps me useless. Darvocet isn't even a strong opiate, it's mostly acetaminaphine. But it helps immeasureably, allowing me to function and cutting the duration of the pain.

My life is liveable because in Mississippi, Doctors can do thier jobs. Here in NY, the A-holes at the state house decide medical treatment, by fiat. They have simply made it so difficult to get decent pain killers, even for those in chronic pain, that the black market in oxycotin up here is better than for recreational drugs.

-Colly

 

[carsonshepherd]

What really bothers me about that, Colly, is that even cancer patients can't get the relief they need. I watched my dad sometimes scream from the pain of cancer. The amount of morphine needed to make the pain stop was illegal. Addicted? For a person with a few months to live what does addiction matter?

The by-product of our national paranoia, the so-called war on drugs.

 

[Colleen Thomas]

What really bothers me about that, Colly, is that even cancer patients can't get the relief they need. I watched my dad sometimes scream from the pain of cancer. The amount of morphine needed to make the pain stop was illegal. Addicted? For a person with a few months to live what does addiction matter?

The by-product of our national paranoia, the so-called war on drugs.

I think here it's the opposite Carson. It's a bi product of making drug addiction someone's fault, other than the person who got addicted. In trying so hard not to make the addict at fault, they have skewed the laws so badly that it's always the prescribing doctor who ends up the culprit. That's just wrong, but after a few ungodly civil penalties no one up here is willing to risk it. So you have to jump through hoops to even get to a doctor who will prescribe them, in this case they are called pain management specialists.

The true culprit here, as in almost all medical problems are tort lawyers and runaway civil suits filed by them. The doctors simply fear a suit from someone who says they ended up addicted to say percocet. the docs just aren't willing to chance you being a sue happy jerk anymore, even when they know you. The lure of multi million dollar punative settlements can make even good folks greedy and the lawyers always convince the plantiff that they aren't actually hurting ole doc morgan, his insurance company is paying for it. They fail to mention Ole doc Morgan will go out of bussiness because he can't afford his premiums.

Viious, ugly cycle.

 

[carsonshepherd]

Well, it's not always just the doctors. A lot of times their malpractice insurance carriers dictate what they can and can't do.

 

[dr_mabeuse]

Well, it's not always just the doctors. A lot of times their malpractice insurance carriers dictate what they can and can't do.

I don't think it's the fear of malpractice as much as it is the Dr's fear of the DEA. I'm sure there are thousands of people in chronic pain from terminal cancer or other conditions who would sign away their rights to sue a physician in return for a little pain relief. The DEA audits the amount of opiates a physician prescribes, and those who arouse suspicion can have their medical license suspended or revoked.

It's kind of hard to believe, but pain management is rather a new medical specialty.

---dr.M.

 

[Colleen Thomas]

I don't think it's the fear of malpractice as much as it is the Dr's fear of the DEA. I'm sure there are thousands of people in chronic pain from terminal cancer or other conditions who would sign away their rights to sue a physician in return for a little pain relief. The DEA audits the amount of opiates a physician prescribes, and those who arouse suspicion can have their medical license suspended or revoked.

It's kind of hard to believe, but pain management is rather a new medical specialty.

---dr.M.

Up here it's an expensive one. Your Gp has to refer you to a Nerurologist, who has to refer you to someone else, etc. etc. before you finally get to the specialist. Your gp can't send you straight to one, nor can your neurologist. If you don't have good insurance, you just can't afford the ofice visits it takes to even get sent to one.

 

[BlackShanglan]

Hmmm. I don't mind them being conservative with the limited-duration pain; for example, last time I did my back in, it took them a week to decide that it was time for the heavy-duty pain meds. That's OK with me; in my rational moments, I really don't want to find an easy path to morphine injections (which was not what I got anyway).

That said, of course I agree that people with permanent and/or terminal diseases need to be managed in another way. It's a completely different story, and I think Dr. M. is right in saying that it's not reasonable to allow our own, non-pain-filled views on opiate use dictate agony for people who have no other options.

I will say, however, that some of this problem - restrictive policing of doctor prescriptions that is - has been brought on by past carelessness. My grandmother, for example, was prescribed some "uppers" after her son's death at a young age, to help her through the grief - and continued to be prescribed them for the next fifteen years. I consider that a problem, but at the time people didn't have the same level of awareness about prescription medecine addiction.

I'm certainly not advising draconian restriction on painkillers - just a bit of caution.

 

[cantdog]

They self-administer when they can, in Maine. The patient has the button on the pump, and gives herself the med as required. There are failsafes, of course, to prevent lethal doses, but on the whole, they find the total usage of narcotics is less with such a device. And people titrate the dose to the pain, so they don't experience the periodic agony before the time the next dose is due.

Very effective and actually gives the patient less meds.

 

[BlackShanglan]

Yes, one of my relatives was on a device like that as well. It's certainly what I would prefer. It seems very sensible.

 

[cantdog]

Well, it does seem sensible, doesn't it? That's why I've always been surprised that it was proposed, or used, or that it continues to be used.

 

[BlackShanglan]

*laugh* Agreed. Humans. Pah.