Chronic Pain Health — 03 December 2012

To understand the war on pain patients, it is necessary to look beyond the current crisis effecting patients’ access to opioid medicines.

Most of those seeking to limit or eliminate our access to these medicines look at the past 15 years, when opioids began to be prescribed more widely to treat pain. The problem with that time frame is that it isolates the current war on patients from the longer history of the war on drugs, first declared by President Nixon in 1972.

Over the last 40 years there have been major developments in the war on drugs that have had deleterious effects on pain patients. Examining a few similarities between the two wars sheds light on our current struggles.

A few statistics first, taken from www.legalizationfacts.com.

In 2000 local, state and federal authorities spent $50 billion on the war on drugs, with an astonishing $20 (billion?) million provided by the federal government. While the government has interdicted huge amounts of illegal drugs and taken them off the street, that interdiction has done nothing to drive up street prices by reducing supply. In reality, prices for many street drugs like cocaine have fallen in recent years.

This war on drugs affects some of our society more deeply than others. In 2006, nearly 1.5 million of our citizens were incarcerated in state and federal prisons. To put that number in perspective, the U.S. has 5% of the world’s population, but 25% of the world’s prison population.

The average length of a federal sentence for a violent felony is 63 months. The average sentence for drug felonies is 75.6 months.

It does not make sense that getting apprehended crossing a state line with a trunk load of diverted opioid medicines will lead to a longer incarceration than shooting a customer during a bank robbery.

The societal damage from these incarceration rates can be seen in these disturbing statistics from the U.S. Department of Justice:

  • Between 1991 and 2007, the number of parents held in state and federal prisons increased by 79% to 809,800.
  • During that same period, the number of children of incarcerated parents increased by 80% to 1,706,600.

This collateral damage has serious implications for minority neighborhoods where large portions of young men are imprisoned for nonviolent drug related crimes. In 2000, nearly two-thirds of all prisoners were African American.

Into this mix is the rise of the repressive surveillance state. After 9/11, Congress created the Department of Homeland Security, and worse, the Patriot Act. This has brought us nationwide search warrants, roving wiretaps, surveillance of computer communications, foreign intelligence procedures applied to domestic criminal investigations, and perusal of library and book records. We’ve seen a steady deterioration in privacy protection and civil liberties.

Restricting Access to Opioids

What, the reader might ask, does this have to do with the current assault on pain patients and their access to opioid medicines? The answer is that this crisis landed in the midst of a country relying ever more heavily on law enforcement solutions to perplexing problems.

Additionally, with our nation divided into red and blue states, there has been a corresponding rise in suspiciousness of each other’s motives. When combined with a latent Puritanical attitude toward pain and drugs, the current assault begins to make terrible sense.

I have heard from several pain patients that friends, family and even spouses often don’t believe that they are really in pain, especially with disorders like fibromyalgia that are not readily visible. Adding to this disbelief is the opposition of family and friends to opioid medical treatment. Many in our society believe that the patient should shut up, make do and move on.

With millions of Americans suffering from chronic pain, the push to reduce access to opioids will put many families in the same predicament as families with a father or mother in prison.

There are parents who suffer from such horrendous pain that — left untreated by opioids — they are as absent from their families as an imprisoned parent is. A parent destroyed by pain may be physically present, but is missing in action from almost all parenting duties, condemned to a life without the iron bars of confinement.

This shows the collateral damage of depriving people with pain the relief that opioids can provide. Just as in families where a parent is incarcerated, untreated or undertreated pain robs a family of a parent; a parent who may not be able to work and who withdraws from social or community life.

Of course, the same can be said for those addicted to opioids or who die from an overdose. But addiction is aberrant behavior in which pain patients do not engage.

Just as there’s been a wholesale destruction of families through incarceration for nonviolent drug offenses, there has been destruction of families with a parent in terrible pain. The repressive organs of state are applying the same discredited law enforcement techniques to a social-medical problem.

Treating unsanctioned drug usage as a law enforcement and military problem has spilled over onto the legitimate use of opioid medicines. Law enforcement agencies now target prescribing doctors, pharmacists, pharmaceutical suppliers and patients. The misguided and destructive war on drugs has spilled over onto the safe use of opioid medicines, thus conflating the two in a way that is harmful to pain patients and their families.

I know that this won’t happen any time in the near future, but we need to end the war on drugs and its cousin, the war on pain patients.

Imagine what we could do with the $50 billion squandered on our international war on drugs and the subsequent high cost of incarcerating nonviolent drug offenders.

Imagine having enough treatment centers for those seeking to kick their addictions.

Think of spending some of that largesse on pain treatment research that could lead to the replacement of opioid treatment for those of us unable to live any other way.

Enough individuals and families have been destroyed. It’s time to end the war on drugs. And it’s time to end the war on pain patients and their families.

Mark Maginn

Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here

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About Author

Mark Maginn, Columnist

Mark is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation.

(11) Readers Comments

  1. Barabara dont get your shorts in a tear. I said that because you asked to have the article sent on to the president. I was suggesting writing to your senators, not because YOU have not, I do not know what you had or had not done, I was making a concrete suggestion as to what could be done.
    And you also have no idea what I, or others, have or have not done.
    There was no shot, I am just going to assume you are having a bad day.

  2. Mr. Maginn is right on the money. Chronic pain sufferers are put in the Government crosshairs along with criminal drug abusers. It’s not only unfair, it’s unconscionable. We chronic pain sufferers do not want to take pain medication, we have to, in order to have some semblance of normalcy to our lives. We wouldn’t wish our conditions on our worst enemies and all we ask is that we get the legal medication that we need.

    Thank you, Mark for your informative article. Please continue to keep this in the eyes of the media.

  3. Carol, What makes you think I haven’t? I’ve written my senator and Pres Obama on six different occassions regarding a variety of pain management issues. I also have arranged presenstations by some of the most notable pain educators in the country for both physicians and nurses. I developed pain management protocols for a well known hospital in Southern California and chaired their pain committee. I also developed an out patient program for patients who are home bound so that they could have better pain management. Next time yu feel like taking a shot, why don’t you aks the right questions, like since the pain care act hasn’t passed, maybe you need to take a look at what senators are getting paid by big pharma like Harry Reid and others. If the jerks who are holding things up are voted back in, then of course it’s not going to pass. A lobby group may help. Form a pain group within your community and help to raise money, or if you belong to a group, get active, protest, meet, petition, run for office.

  4. Barbara Johnson, It is better to write to your senators and ask why they have never voted on the National Pain Care Act brought before them in 3 different sessions. The House passed, the senate cannot be bothered.
    This is the bill: http://thomas.loc.gov/cgi-bin/query/z?c111:S.660:

  5. Nice article, Mark. Hit the nail on the head. Would you please seb the article to Pres Obama? He has the ear of some folks who are very misguided. One thing I would like to say is that while pain patients are either not treated, under treat or have little or no acess to the meds they need, they end up in Emergency Rooms. At that point, the desperation sets in and after a couple of times in the ER, the pain patient is labeled as a ‘drug seeker’ or as having ‘drug seeking behaviors’. The emergency room physicians should be board certified in not only emergency medicine, but also be required to have a board certified physician in Palliative Care who can accurately diagnose chorinc pain and treat it efficiently and effectively. Since the Nation Institute of Health has completed it’s recent study that 110 million Americans have chronic pain, this should be a no-brainer. What do you think?

  6. Ending prohibition would greatly reduce, even almost eliminate, the market in illegal narcotics, cause a reduction in the number of users and addicts, greatly curtail drug related illness and deaths, reduce societal harm from problematic abusers, and bring about an enormous reduction in the presence and influence of organized crime. The people who use drugs are our own children, our brothers, our sisters, our parents, and our neighbors. By allowing all adults safe and controlled legal access to psychoactive substances, we will not only greatly reduce the dangers for both them and ourselves but also greatly minimize the possibility of ‘peer-initiation’ and sales to minors.

    If you sincerely believe that prohibition is a dangerous and counter-productive policy then you can stop helping to enforce it. You are entitled—required even—to act according to your conscience.

    * It only takes one juror to prevent a guilty verdict.
    * You are not lawfully required to disclose your voting intention before taking your seat on a jury.
    * You are also not required to give a reason to the other jurors on your position when voting. Simply state that you find the accused not guilty!
    * Jurors must understand that it is their opinion, their vote. If the Judge and the other jurors disapprove, too bad. There is no punishment for having a dissenting opinion.

    “It is not only [the juror’s] right, but his duty … to find the verdict according to his own best understanding, judgment, and conscience, though in direct opposition to the direction of the court.” —John Adams

    We must create what we can no longer afford to wait for and end the most destructive, dysfunctional, dishonest and racist social policy since Slavery: PLEASE VOTE TO ACQUIT!

  7. Thank you Mark for keeping the spotlight on this subject! I know how my conditions (and pain) have affected my family–having missed out on so many of their memories…even more so with the heartless blind cut of medications to pain patients, I am unable to contribute even less now…my children come home and come straight to my bed as that is where they expect to find me.

    I have to pick and choose which events of their lives I can participate in as I am not adequately medicated, so I try to plan for weeks ahead of an event–in the hopes I can make it. They are constantly frightened waiting for me to scream out (and I truly try and never do that), but twice this last week I was struck with such pain that brought me to the ground, unable to move after each one of them; “Mommy!!!” “should I call 911?”….(what’s the point I think), “No no, Mommy is fine”, I grit out through my teeth, as my husband slowly assists me across the room which seems like an eternity until I am positioned into bed, the door securely closed and pillow over my face so I can scream and cry and let it all out.

    I hope the next addict that is shooting up for fun or the heck of it realizes the true damage they are causing to so many people that need these medications just to live.

  8. Mark, thank you for this article! I deal with chronic pain due to a degenerative spinal condition and fibromyalgia, and I am a victim of the war on chronic pain patients. New legislation in my state of Kentucky has almost every doctor terrified to truly treat patients dealing with chronic pain. The minute you walk into a pain management clinic, you are made to feel like a drug addict. I understand the need to keep the drugs out of the hands of those who abuse the medication, but the result is that those of us who truly suffer with chronic pain are being severely undertreated. Thank you for shedding light on this subject.

  9. Hi Mark,
    Your so right! Families are being affected at an alarming rate. If the parent can’t work then the house gets foreclosed and children don’t eat, much less get any love and attention. As for Florida, Nothing has gotten better down here. yes.. it has quieted down but NO! Things are not better. I think many people feel that nothing will help right now, until the govt gets back to work and that is very sad. Still pharmacies that have filled before suddenly say NO, we don’t have that. How much more dangerous can this get? patients should not be told no with legitimate prescriptions, it’s still happening. I also would like to know just how many have been to ER with withdraw symptoms that are legally prescribed? I know there has to be a rcord somewhere. The news has said nothing about it. So many people are not having Happy Holidays. Many I know? Are stressed, suffering and scared. This is no way to live. I really wish that all these articles that you have written could find a way to the Senate and Congress to read. They most likely have no idea how people badly legitimate pain patients are being affected by all this and if they do know? Shame on them.. All the articles your writing are right and to the point. Does anyone have a way that we can get these to the people with power to help change this living hell?
    Also, I have reports that Kentucky and Ohio legitimate patients are having a terrible time as well getting access to pain care. Many in KY are left with zero care, so all of this has become a HUGE nightmare for people with pain. If there are over 100 million people in pain? Our country is in trouble. If this medication problem keeps up? We will have the record amount of people in any country on disability.

  10. Nicely said but I do have a few quibbles.
    Mr. Maginn writes “war on drugs and its cousin, the war on pain patients.” I would venture to say these are not separate but related but one and the same. The “war on drugs” has been a colossal failure and a colossal waste of money. We do not see a lot in the news anymore about drug cartels or large amounts of heroin or cocaine or meth, for instance, being found and the owners prosecuted. Instead we see many articles, in mainstream media, about the ‘presription pain medication epidemic”
    In googling to find articles I see over and over prescription opiods, addiction, and and chronic pain in the same link.
    What I never find in any of these articles is a breakdown of the numbers of those abusing, overdosing, or dying as a result of taking their own presecription meds as opposed to those who beg, borrow, or steal these drugs.
    What I read is/are anecdotes by or quoting someone who says they were in chronic pain, prescribed opiod(s) and then they were hopelessly addicted and required treatment. No where does it give the information as to whether the person had a history of abuse/addiction prior to be given the narcotic medication(s).
    As to disbelief of those in pain, as the owner of an FB pain support group, and member of many others, I find that part of the disbelief many of us have faced is a result of the invisibility, and the disbelief by the medical community of certain complaints, such as those that constitute fibromyalgia, but there is also another issue often in play; the inability to believe or refusal to accept that there is such a thing as constant, chronic pain.
    People mostly know pain as what they feel when they break a bone, get a bad cut, etc. Even recovering from major surgery has an endpoint. Chronic pain does not. If I accept your pain then I have to acknowledge that this horrible state of affairs actually does exist and if I accept it as a truth for you could it then become a truth for me?
    People live much of their lives in denial. John has cancer but he smoked, I never smoked therefore I will not get cancer, the first example that comes to mind. Chronic pain does not exist, I sprained my ankle 6 weeks ago and the pain is gone therefore chronic pain does not exist, you get hurt – you get better.
    As long as there is not a good educational campaign in this country (and elsewhere) about the reality of chronic pain, what causes it, how it manifests and how it is addressed medically, the denial will continue and so too will the lack of research funds which could be the answer to finding alternate forms of medications outside of the opiates.
    Carol Levy
    author, A PAINED LIFE, a chronic pain journey.

  11. Thanks, for another great article Mark! I have often thought about the toll that my pain has had on my family. I know that BEFORE I was properly diagnosed with a painful, genetic, connective tissue disorder (Ehlers-Danlos Syndrome), and finally treated with opioids, my family suffered terribly from my “absence” due to severe pain. I could be in the room with my young children, and as much as I adored them, all I heard was NOISE when they were talking. I couldn’t follow a conversation, concentrate, laugh, play….. It was AWFUL. The minute my husband came home from work, he took over with the kids, and i went into our bedroom and burst into tears from AGONY. I would lie in bed with ice packs and heating pads, just rocking back and forth from pain. I was on MAX daily doses of NSAIDS & Tylenol, doing PT & accupuncture weekly, meditating (trying to),soaking in Epsom Salt baths three times a day, and only sleeping two hours at a time. I didn’t leave the house unless it was for medical appointments, couldn’t go to the grocery store, etc. Being a wife and mother with UNtreated severe pain, put a tremendous burden on my husband. Both of our families lived thousands of miles away. life was just survival. Not the usual, everyday, trying to survive life with small children at home…. It was literal survival. I didn’t know how I would make it from one minute to the next. My body had completely failed me, and I felt like I was being tortured!

    When I was finally properly diagnosed, and my pain was treated with Opioids, life became manageable. I started sleeping at night, was able to play, read, and laugh with my children. I could make dinner, and even go to the grocery store for a few items. My husband didn’t have to rush home from work every day because his wife was suffering. Our finances improved, and I wasn’t spending thousands of dollars in treatments that didn’t work. I got my LIFE back. My husband got his wife back, and most importantly, my kids got their mom back.

    If I were to suddenly stop having my pain treated, or my doctor couldn’t prescribe my medication (or wouldn’t out of fear), or my pharmacy stopped carrying my medication because of a shortage, or FEAR….. My life would fall apart again. And with me, I would take my husband and children’s quality of life. I would disappear & crawl back into bed, in tears, wondering HOW medically necessary medication was suddenly taken from me. Wondering why my family and I had to suffer so severely, because someone who wasn’t supposed to, took medication like mine, and overdosed on it.

    All these unintended consequences, like family members who have to disengage from life because of untreated pain. Or, we criminalize the people with addiction, put them away, and banish them from their families lives. So, what we end up with is a bunch of UNtreated pain, and a bunch of UNtreated drug addicts. BOTH medical issues that become moral and legal ones. Well, it seems the trend these days has been an enormous resurgence in the use and abuse of HEROIN. Maybe the plan is to turn all the untreated pain patients into self-medicating drug addicts. THEN, we can get rid of all the people with genetic tendencies towards painful medical conditions, along with those with substance abuse problems….. HIDE them away in jails and institutions, while the politicians congratulate themselves on a job well done! THIS is the new “WAR on drugs!”. Brilliant!