Pubdate: Tue, 06 Jan 2004 Source: Atlanta Journal-Constitution (GA) Copyright: 2004 The Atlanta Journal-Constitution Contact: http://www.accessatlanta.com/ajc/ Details: http://www.mapinc.org/media/28 Author: Philip Terzian, Providence Journal Bookmark: http://www.mapinc.org/people/rush+limbaugh Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) Bookmark: http://www.mapinc.org/find?232 (Chronic Pain) PAINKILLERS THE NEW VILLAIN IN DRUG WAR Everyone's had a good laugh this season at Rush Limbaugh's expense: The news that Mr. Know-It-All Conservative was addicted to prescription painkillers was nearly as pleasing to critics as the prospect of his indictment for buying controlled substances. Yet Limbaugh is more emblematic than people might imagine. It is estimated that some 50 million Americans suffer chronic, sometimes debilitating, pain of some sort, and medical progress to treat this human torment is on a collision course with the war on drugs. Physicians who prescribe painkillers, especially such effective morphine-based nostrums as OxyContin and Lortab, to suffering patients are now treated with suspicion by agents of the federal Drug Enforcement Administration. Undercover ''patients'' are sent to doctors' offices with fraudulent complaints, and pharmacists are directed to report ''suspicious'' patterns of pain relief. Some physicians who specialize in pain relief have been arrested, some indicted and tried, and a few have been imprisoned. Many have lost their licenses to practice medicine, and all have incurred mountainous legal bills. No doubt, there are some substandard doctors out there, but there is a large difference between purposefully defying the law for profit and relieving people's chronic pain. That the frontiers of pain relief involve opiates fraught with emotion and history --- morphine, opium, etc. --- seems to have dangerously distorted civic judgment. After a prominent Washington-area physician was indicted for prescribing large doses of OxyContin, Attorney General John Ashcroft spoke as if he had nabbed a Colombian drug kingpin: The pursuit of Dr. William Hurwitz, said Ashcroft, shows ''our commitment to bring to justice all those who traffic in this very dangerous drug.'' Unfortunately, it tells us something about the national state of mind when a singularly effective pain-relieving narcotic is regarded as a ''dangerous drug.'' No doubt, drugs such as OxyContin are ''dangerous'' in the sense that, as narcotics, patients can become dependent on them, and they should be consumed only under a physician's supervision. But what is it about the effective relief of pain that transforms a lawyer-politician like Ashcroft into a man of science, or puts the cops-in-suits at DEA in charge of the medical profession? Part of the dogma, I suppose, is a vestige of the notion that suffering is good for the soul. The United States is particularly backward in its presumption that pain may be deserved and ought to be endured, and that the pitfalls of relief --- addiction, dependence --- are infinitely worse than the agony itself. This principle is applied to people dying of cancer, children in torment, patients in their 90s. Addiction to any sort of opiate can be dangerous, but in the present scheme of things, it largely depends on the particular kind of opiate: Your dependence on a dry martini every evening is acceptable, even convivial; your daily ministration of Demerol is evidence of depravity. To that end, painkilling drugs are treated like radioactive waste, grudgingly distributed and clothed in all the trappings of criminal law. The paradox here is that the science of pain relief has advanced steadily in recent years, and people who endured years of chronic torture are now able to control and overcome discomfort with new drugs and new specialists devoted to pain management. At the same time, the war on drugs has followed the pattern of bureaucratic growth, and revised and expanded its power over citizens. Having failed to affect the heroin trade or reduce the demand for designer drugs, the DEA is now battling the healing art. Instead of finding doctors to alleviate their torment, patients will find SWAT teams wrestling physicians to the ground. In pain? Take two aspirin and call Dr. Ashcroft in the morning. Philip Terzian is the associate editor of the Providence Journal. - --- MAP posted-by: Larry Seguin