DRUG POLICY AND PAIN MEDICINE

The Anatomy of a Witch Hunt
By Dr. Frank Fisher M.D.


A Speech To the MPP
(Marijuana Policy Project)
11/08/02



Introduction

Iím a general practitioner. I got my medical training at Harvard, and Iíve spent my career taking care of disadvantaged patients on Indian reservations and in community clinics. Along the way I developed an interest in the management of chronic pain. This led to an encounter with the California Attorney Generalís Office, which Iíll share with you a little later.

Iíd like to thank the Marijuana Policy Project for inviting me to discuss drug policy and how it affects medical care. The field of pain management is currently in a state of crisis. Iíll explain how this situation came about and the damage it does. Then Iíll suggest that addressing the pain crisis may represent the next major step towards solving all of our current drug policy problems.

Everyone knows the DEA is trying to keep patients from getting marijuana. This is only the most obvious way that drug policy interferes with medical care. A more insidious drug policy keeps patients from receiving pain medicines. As a result, millions of patients with chronic pain suffer unnecessarily and many die. The demonization of a class of medications known as the opioids, is at the root of this suffering.


Treatment

We recognize the opioids by names like codeine, Vicodin, and morphine. These medications control pain safely and effectively. Unfortunately, drug policy prevents doctors from prescribing opioids for chronic pain.


Legislation

State legislatures have recognized this problem and responded by enacting laws, encouraging doctors to prescribe opioids. This should have solved the problem but it hasnít. Instead of respecting written policy, law enforcement regards doctors who prescribe opioids as criminals. What could drive law enforcement to this insanity? The answers lie in the history of opioid prohibition, the myths that demonize opioids, and the nature of bureaucracies, all of which we will examine.


Prohibition

Opioid prohibition started in 1914 with the Harrison Act. This act banned opioids, except for their use in medical practice. Law enforcement immediately made it a clean sweep by assuming that doctors, who prescribed opioids for chronic pain, were drug-dealing criminals. The witch-hunt was on. After 88 years, the fox is still watching the chicken coop.


Mythology

The witch-hunt against pain doctors is driven by myths about opioids. John F. Kennedy explained the power of myth, when he said, ďThe greatest enemy of the truth is very often not the lie Ė deliberate, contrived and dishonest Ė but the myth Ė persistent, persuasive and unrealisticĒ.

A core belief in our society is that opioid addiction is the ultimate evil. Naturally, we fear a substance that is said to be able to take hold of us and never let go. These myths are the emperorís new clothes. Opioids are actually the safest drugs a doctor can prescribe for pain and addiction is rare. Another myth warns us against evil, opioid prescribing doctors, who are said to be nothing but drug dealers in white coats. The persistence of these myths is the underlying problem preventing rational development of drug policy.


Bureaucracies

Itís easy to understand why law enforcement created myths about opioid addiction...but why the myth about drug-dealing doctors? To understand this myth, we have to look at the nature of bureaucracies. The overriding purpose of any bureaucracy is self-preservation. Without widespread fear of opioids, the 'War on Drugs' goes belly up. If doctors were allowed to prescribe opioids for chronic pain, people would discover how safe they are. The witch-hunt against pain doctors prevents this.


Consequences

The witch-hunt has deadly consequences. Doctors respond by prescribing dangerous drugs, instead of opioids. Chronic pain is often treated with drugs like Motrin and Naprosyn, which cause bleeding ulcers that kill 16,500 patients a year. To put the body count in perspective, itís like having an Oklahoma City bombing twice a week. Drug policy is directly responsible for these preventable deaths.

The DEA ignores this, choosing instead to whip the media into a frenzy over the deaths of a few Oxycontin abusers who obtained the drug illegally. The DEA terrorizes doctors with the threat of criminal prosecution. My colleague, Dr. Robert Weitzel is on trial in Utah right now, accused of 5 homicides that he didnít commit.


Personal

The California Attorney Generalís office is trying to put me away for 20 years. Back in 1998 I was running a community health center in a small Northern California town. I prescribed an opioid called Oxycontin to some patients with chronic pain and they benefited from it. The State Attorney Generalís office reacted by launching a commando style raid against my clinic.

They accused me of mass murder and threw me in jail. My bail was set at $15 million dollars. They announced to the media that I had created 5,000 drug addicts, by flooding the community with narcotics. They closed my health center and tossed my patients into the street to fend for themselves. And you marijuana providers out there probably think you had a bad day when they come and rip your plants out!!

You can read the rest of the story on my Web site, just Google Dr. Frank Fisher. But Iíll tell you about one of the murders. A patient I was treating for chronic pain was a passenger in a car crash. Her skull was crushed, her neck snapped, and her heart exploded. This was a terrible accident, and any one of these injuries would have been fatal. The coroner who did the autopsy found opioids in her blood and concluded that somehow, in spite of her injuries, she must have died from a drug overdose. I was accused of murdering her.


Summary

Iíll summarize the effects of current drug policy on pain management. Drug policy denies chronic pain victims the medicines they need in order to enjoy productive lives, or in some cases just to survive. In effect, the government has declared war against the weakest and most vulnerable members of society. This war is being waged through the intimidation of healers who care for the sick and the dying. The result is an ongoing public health disaster. This will continue until we, as a society, reject the myths surrounding opioids.


Conclusion

Iíll conclude with a couple of remarks about the implications of this situation for drug policy. The fear of opioids permeates our culture so deeply, that it controls the debate about all the other drugs. Until this changes, itís unlikely that drug policy will make any significant advances.

I invite the Marijuana Policy Project to form an alliance with the medical profession. I recommend that you commit a portion of your considerable resources to debunking the lies and myths surrounding opioids, and to exposing the witch-hunt against pain doctors. Solving the pain crisis is the key, to changing drug policy.


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