Providing straightforward information pertaining to drugs, drug use & drug policy. The Grey Pages promotes drug-related literacy and advocates a system of viable and tolerant drug policies. This is my personal collection of commentaries, essays, tid-bits, and other such writings on everything ranging from drug use, drug policy and drug-myths, to drug-science, addiction, human behavior, and the workings of the human brain. I started this blog with a particular focus on opioids, and over the past year have found my interest gravitate toward the intriguing, ever-changing world of designer intoxicants (i.e. "research chemicals" or "designer drugs").

Wednesday, July 20, 2011

Chronic Pain & The Anti-Opioid Crusade (Collection)

The Balancing Act Illusion

Nowadays, highly trained medical doctors risk criminal prosecution on a daily basis. There is now substantial risk to treating patients as humans and providing effective pain relief in good faith. To be hunted, persecuted, convicted, and to spend several decades in prison does not require any degree of malice or even negligence - But rather some major publicity & manipulation, along with a parading of addicts & grieving families of addicts in the courtroom - ensuring no chance of a rational decision by a jury.

Medical Boards of Medical Doctors no longer set standards in practice; prosecutors, drug agents, and juries do. The federal government demands that doctors practice a futile "balancing act" between compassionate care and policing patients. Physicians apparently must forsee the possibility of individual patients snorting, injecting, overusing, or selling their prescriptions. Society, now holds doctors personally responsible for what irresponsible & conniving patients do with their medications.

The dwindling number of physicians who choose to even treat patient suffering (a fundumental duty of the physician I might add) must choose from a) treating pain liberally using the opioids necessary, giving patients the benefit of the doubt, and inevitably allowing a few "fakers" to slip through the cracks, or b) helping the government battle drug use, restricting patient access to drugs and inevitably refusing treatment to many who need it, and undertreating those who require higher doses.

Keep in mind there is no objective means of measuring pain. In addition, not all pain-related pathology is visible via radiology (MRI, Xray).

From an objective, intelligent, and not to mention humane, standpoint, it is far preferable for a minority of "fakers" to slip under the pain policing-radar - even if a portion harm themselves or lose their lives due to a stupid personal choice - than for one genuinely suffering individual to be deprived of convenient access to narcotics for their pain, cancer or non, without having to jump through hoops.

Underlying everything - the paramilitary SWAT assaults on individuals over some pills or powder for personal use, the sensational rhetoric, the voodoo pharmacology, the fear-journalism, the thought stopping hysterical & emotional bantering - is the indisputable, science supported fact that such opium-based narcotics, even heroin, are safe and non-organ damaging when taken intelligently even over chronic periods.

Florida & The "Pill Mill" Crisis

Let me make something very clear. Florida Pain Doctors do not seek out innocent individuals on the street to 'prey' upon... To the contrary - Anyone who waits for hours on end in a line out the door & pays hundreds of dollars only in cash to see a doctor whose primary focus of practice is the sensation of "pain"; is undoubtedly SEEKING narcotics. While going to obvious lengths to do so.

No one can argue that a single one of these patients have ended up at such a clinic inadvertently, with childishly naive intentions. No one is referred to a cash-cow clinic by their trusted, life-long, friendly family physician.

No one can argue that a single one of these patients are oblivious to the non curative & strictly supportive nature of the treatment they are receiving; or to the medico-ethically ambiguous nature of the facility they are receiving it from.

No one can argue that any of these patients are not already well aware of the potentially habit forming nature of chronic narcotic use.

And last but not least, even if such individuals are ill informed, that's all on them - Black Box warnings and "Prescription Drug Information" packets aren't stapled to the walgreens bag to make paper nose straws out of.

Making Criminal Issues out of Civil & Medical Board Issues:

The Case of Conrad Murray: I've been periodically keeping track of the trial of Michael Jackson's physician, Dr. Conrad Murray. I believe this case is a perfect demonstration of a practice which has become all too common, and that I refer to often, this practice being; Blaming Others, and embarking on all out witch hunts that won't end until something or someone can be blamed and persecuted for the incompetency of others. These witch hunts seem to follow any high profile death - And of course to a less publicized but much more massive extent, the deaths of the young lay folk - most often related to the ignorant & grossly reckless misuse of prescription drugs. On to my point...

I think most of us would agree that the propofol was administered by Jackson himself. I strongly detest the seriousness of the charges against Dr. Murray. It is highly likely that Murray may spend at least a couple of years incarcerated.

This is by no means to suggest there was no negligence on the part of Dr. Murray - To the contrary; for Murray to leave a powerful anaesthetic unattended with his patient is a clear deviation from ethical medical practice which shouldn't be ignored. Though I would argue against any accusation of 'moral' wrongdoing, a board certified physician is accountable to uphold a strict set of ethical standards much different than a drug dealer or layperson - regardless of who the patient is, regardless of the mutual level of trust or the nature of their personal relationship.

Having said that, Murray is definitely guilty of negligence, perhaps even gross negligence... The problem I have is that such allegations, which are clearly an issue of Medical Ethics to be dealt with through Civil Suits and Medical Board sanctions (license revocation, fine, etc) have been turned into a Moral & Criminal issue which is being dealt with through Criminal Court and FELONY charges.

On a final note, I believe Dr. Murray should certainly be held accountable for negligence, but should not whatsoever be held responsible for "killing" Michael Jackson. Assuming the pop-star had been dosing the drug himself, Jackson's death is all on Jackson - i.e. Jackson killed himself by being a fucking moron and using anaesthetics improperly while under the influence of multiple other drugs.

Solution - Sell the shit over the counter to adults. Let the Doctors deal with the REAL medical practice while utilizing such drugs for their intended clinical purposes.  

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