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Treating Pain During a Drug War | ||||||||||||
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by Siobhan Reynolds, October 19,
2003. Ms. Reynolds is a family member of a chronic pain patient and the
Founding, Executive Director of the Pain Relief Network -
http://www.painreliefnetwork.org/ - "PRN: Standing up for patients
in pain and the doctors who treat them." | ||||||||||||
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There is no realistic fear of diversion in a pediatric oncology unit and yet clinicians there won’t give adequate analgesia to dying children! The problem is not about how risky the patients are, in hospitals or clinics, or in private practice. If it were, the dying children on pediatric oncology units would be getting help. It isn't even about the clinicians, most of whom do an otherwise fine job. The problem is pain care. It is about the government and its relationship to pain care, analgesic medications, and clinicians who would treat pain. In the hospital, in the pediatric oncology unit, the nightmare is laid bare. The drug war bureaucracy threatens the medical system at many levels, with varying degrees of bullying and violence. In turn, the medical community has made adaptations in the way pain care is delivered to avoid being on the direct receiving end of the violence. What patients are accepted into treatment, what medications are used, and for how long and in what doses -- every single aspect of pain management and of the relationship between doctors and patients in America has been distorted by the imperatives of the War on Drugs. These adaptations have resulted in a civil rights and health catastrophe for patients. It's like being in a family with an abusive parent. The violent one doesn't need to hit every person in the family at all times in order to keep the system functioning in a way that maintains his authority. He only needs to demonstrate that the consequences for crossing him will be severe. The family will keep itself in line. Some people in the family will even believe that they aren't getting hit because they are better than those who are. The family will work together to portray itself as a normal "free" family to the outside world. It is a complex system of denial and social control and it is commonly referred to as dysfunctional. This is how the pain management profession is working under the abusive authority of the DOJ and the War on Drugs. The few brave physicians who are willing to attempt to treat pain at all under these conditions end up spending an inordinate amount of time nitpicking the dysfunctionality of their ill patients, worrying about this prescription and that behavior and about what the pharmacist might think, and agreeing with the DOJ at the FDA hearing about how important it is to develop better "patient selection" (really patient rejection) procedures. Only in an American medical system so perverted by the Drug War would we find physicians, whose allegiance and attention and diligence should be focused on their trusting patients, collaborating with Purdue Pharma (!) to develop a system of "key informants" to combat the "rising tide of addiction." Good grief. What keeps the thing working for the Drug Warriors is that as a group, the doctors can't really find fault with a system that holds them to a standard of omniscience. Overall, they appear to think, its fair! And then the humble docs, the ones who are out there just doing the job, who know their limitations and are treating the pain, they get destroyed, arrested, their money seized by the government, their lawyers chased off. And the physicians who aren't getting similar treatment believe it is because they are somehow better than the docs being hauled off to jail – that those guys must have deserved it. It's a sad and sorry display. But it doesn't have to be this way. There is another solution. Families overthrow abusive parents all the time and the medical profession could refuse to play along with its abusive parent. It is our government after all. We don't need to pay them to do this to us. But first, you'd have to admit that the thing is a horrible, immoral mess and stop blaming the patients and each other. And then we'd all be working together toward a world where we all get pain care. Dying children and everyone.
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