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06 November 2005

How much does it hurt?

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Concern about the potential for addiction commonly prevents physicians from adequately prescribing sufficient analgesics to their patients who tell them they are in pain. In America this is compounded by the terror physicians have of attracting the scrutiny of the Drug Enforcement Administration -- a scrutiny that could easily lead to the loss of their federal license to prescribe controlled substances, or very commonly in the last five years, to U.S. Attorneys bringing criminal charges against physicians, which have often led to convictions and prison sentences.

One problem facing medical professionals is that the perception of pain is largely subjective; the patient perceives he or she is in severe pain, but the nervous physician concludes the patient is exaggerating, and there is little or no objective way to resolve the question. Pain isn't like a white blood count or a blood sugar test which reliably returns an objective number.

Studies conducted of surgical patients routinely conclude that severe post-surgical pain is routinely under-treated, either by physicians under-prescribing or failing entirely to prescribe, or by nurses holding back from offering optional narcotics to patients reporting pain.

Nevertheless, in the last 15 years, some physicians and medical schools have established pain management as a science founded on objective principles. Above, the Wong-Baker FACES pain rating scale, particularly useful for hospitalized children whose vocabularly is inadequate to describe the severity of their pain to adults. It was developed by Donna Wong, Ph.D., RN, a pediatric nurse at the University of Oklahoma.

But adults can pick a Number from 0 to 10. One can surmise that if a patient has abuse or addiction issues, the number pattern he/she will chart over a period of a few days will be quite reognizeably different from the pattern reported by a patient just wishing to have his/her pain relieved.

If subjectivity is a problem in managing pain, so is puritanism. So what if a terminal cancer patient becomes an addict? So what if anyone is getting chemically euphoric? How, exactly, did the Declaration of Independence's guarantee of a citizen's right to the Pursuit of Happiness become a felony in the last century?

Marijuana has been known for thousands of years to effectively relieve a variety of ailments, including pain, and US voters and state legislatures have passed laws allowing citizens access to marijuana without subjecting them to the usual criminal penalties. The federal government is ripshit about these laws and busts everyone in the medical marijuana community anyway. Federal and state police routinely toss seriously ill cancer and AIDS patients in jail and prison for marijuana possession and cultivation. The official opinion of law enforcement is that citicans are only allowed to use alcohol if they want to get artificially happy.

A particularly vile practice was the routine threat of the DEA to yank the controlled-substance prescription licenses of physicians who merely talked to their cancer chemo and AIDS patients about marijuana's powerful appetitite-stimulating properties. The federal Ninth Circuit Court of Appeals ordered the DEA to knock that shit off, ruling that the DEA was violating a physician's First Amendment free-speech rights.

Addiction and abuse are indeed problems, and things to be avoided and overcome. But by physicians, nurses, pharmacists and other medical professionals who have training and whose only goal is to improve a patient's health.

This is none of the business of cops, prosecutors and prison guards. The Puritanical Terror of Anyone Being Temporarily and Artificially Too Happy has made the Land of the Free the biggest Gulag in the world.


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