PAIN RELIEF NETWORK
MISSION STATEMENT
PRN was formed to oppose and expose the Federal
Government's crackdown on opioid prescribing that began in earnest following that
the attacks of September 11, 2001. As we developed our approach, and
implemented our Clinical Litigation Project, we took the opportunity to investigate
the myths and misperceptions that have infected the national and world
consciousness as regards pain, the purpose of medicine, and opioid drugs.
Physical pain is what people fear most about dying. A dying person in pain
cannot think about anything else, leaving no room for coming to terms with
death, for reviewing one's life, putting one's affairs in order, for saying
good-bye. The same, of course, is also true of someone trying to live in
excruciating pain. But to imagine that this eventuality might befall one, should one
suffer a catastrophic accident or illness - to imagine that a physician will not
come to one's aid under such circumstances, is impossible. So rather than
entertain the idea that this could happen (and the truth is, will likely happen,
should one find one's self in severe chronic pain) as a society we live in the
denial of this possibility and have created for ourselves a myth of available
care. It is under the cover of darkness provided by this myth that the Drug
Enforcement Administration has been running physician prosecutions.
The culture of non-treatment of pain can be seen, however, in all aspects of
medical care. According to Dr. Russell Portenoy, Chairman of the Department of
Pain and Palliative Care at Beth Israel Medical Center:
"Unrelieved pain is a huge public health problem and is absolutely
devastating to individuals and families. Although patients with pain should expect to
see health care professionals with state-of-the-art knowledge of pain medicine,
this is not the case. Although patients with serious medical illnesses, like
cancer or AIDS, should expect to have pain routinely managed, undertreatment is
common."
Not even dying children are exempted from the chilling effect of drug
prohibition on palliative care, as the parents of 89% of children who died in Boston
hospitals during the 1990's reported that their children suffered “a great deal
” before they died.
Jane Brody revealed in the New York Times (February 8, 2005) that physicians
do not prescribe opioid painkillers in doses sufficient to kill pain, not even
to Jane Brody. She reported, in fact, that her doctors decreased her dose
of opioids in response to her report of increased pain following elective
surgery. This sort of damaging and irrational treatment is the norm. Physicians
cannot think rationally about these drugs because prescribing them poses a
serious threat to their livelihoods and liberty. Luckily for Ms. Brody, she
recovered from her knee surgery and her pain ceased. But many millions of people are
not so lucky and are precluded from recovering from otherwise eminently
survivable illnesses and injuries because physicians cannot treat pain with
appropriate dosing. For these people, their lives are over, their marriages crumble,
their children are taken from them, and they fall into poverty. They do not want
to commit suicide but are forced into it by their extreme circumstances. And
since we as a society fail to even record the incidence of suicide resulting
from untreated pain, this carnage is going on unacknowledged and unquantified.
People in severe chronic pain are the most disenfranchised and voiceless
minority in America today. Existing in the darkness created by the myth of
available care, their daily lives are truly a hell on earth. Once people in pain find
that they require daily opioid pain medications, they are met with derision
and suspicion, treated as though they are criminals by their physicians,
subjected to mandatory drug testing, and coerced into signing away their medical
privacy rights to law enforcement. Silenced by the shame created by their
status as non-persons, their “drug-seeking” often misinterpreted by their friends
and families, people in pain live lives of horrific desperation. We all
participate in these people's isolation in that we all seek to deny the possibility
that our fellow man would abandon us to infinite suffering. Unbeknownst to
almost all of society, the criminalization of opioids and the ninety years of
anti-drug propaganda that has accompanied drug prohibition has reinforced this
perfect circle of hell on earth for people struggling with pain.
At PRN we have confronted the Government's high profile crackdown on the
pain movement, both inside and outside the courtroom. Through our Clinical
Litigation project, we have developed core documents and tactical approaches which we
have shared with many prosecuted physicians and their attorneys around the
country. In our media and public awareness work, we have been using the
publicity generated by these criminal prosecutions as an opportunity to educate the
citizens regarding the connection between the lack of available care and drug
prohibition. On several occasions we have gone to Washington, DC to brief and
meet with Members of Congress. And we have engaged in a steady campaign of
'grass-tops' organizing, pushing the academic pain and addiction physicians to
tell the truth regarding the nature of the threat posed to them and their
brethren practicing in the communities. Thus far, we have managed to make
undertreated pain a national issue and along side it, provoke awareness that physicians
are being prosecuted for prescribing pain-relieving drugs in good faith. The
National Association of Attorneys Generals has taken the DEA to task for its
overzealous behavior, and the AMA is becoming increasingly involved in reporting
the crisis in undertreatment.
Still, there is much work to be done. We are redeveloping our website to
harness the growing awareness we have generated and to turn it into an active
political constituency. We are also working to move organized medicine to take a
stand against the DEA and to support legislation which will clarify the
language in the Controlled Substances Act, making the state's regulation of medicine
explicit and operative.
Finally, what our analysis has revealed is that drug prohibition has saddled
medicine with a set of law enforcement imperatives that operate in direct
conflict with the humanitarian mission of medicine. It is this fundamental error
in social policy, which we seek to remedy. Our ultimate goal is to free
medicine of these imperatives and to normalize societal attitudes toward opioids
throughout the world.
Siobhan Reynolds
President PRN
