Sympathy for the Doctor

Time has a sympathetic account of the predicament facing Billings, Montana, neurologist Richard Nelson, whose practice is under investigation by the DEA, apparently based on rumors of inappropriate painkiller prescriptions. Nelson has not been charged, but he has been forced to stop prescribing opioids, leaving many of his patients without treatment. Far from a Dr. Feelgood or heedless maverick, Nelson comes across as a a respected and careful physician who tried to do everything by the book. His case apparently was troubling enough that it prompted Time to take a broader look at the conflict between drug control and pain control. Headlined "Why Is the DEA Hounding This Doctor?," the story (which also mentions the conviction of Virginia pain doctor William Hurwitz) concludes this way:

Even if he is eventually absolved, the Montana native plans to close his practice. "We thought we were doing everything just about right," he says. "But now a whole bunch of people are sitting out there hurting like hell."

[Thanks to Siobhan Reynolds for the link.]

Comments

[Ben]

John Tierney's column in the NY Times today also deals with the DEA's war on people in pain. Barbaric was the first word to come to my mind after reading it.

[jane]

All opiods should be completely banned. Modern medicine has safer non-addictive medicines, such as NSAID anti-inflamitories and anti-convulsants.

[js]

Well if you don't want to take opiates for that pain theres an interstate commerce affecting substance that ...

Actually, I'd bet that opiates are often more effective at pain relief than mj and yet almost always more addictive (and thus mj is preferable in my mind, when it is effective). The fact that opiates tend to be more addictive makes it kind of bizarre that they can be bought in legal form and yet mary jane can simply not be had that way. Ah well blame big pharma or blame nothing and just conclude the laws make no sense.

[R C Dean]

Modern medicine has safer non-addictive medicines, such as NSAID anti-inflamitories and anti-convulsants.

I know a couple of pain doctors who would disagree with this. They know that prescribing opioids puts them at risk, but they do it anyway because they have a good reason to do so. That reason is that, for some kinds of pain, there is no substitute.

[blammo]

Doctors need to get off their asses, organize, and get political over this shit.

What medical orgs are fighting this thing? It's ridiculous!

[Highway]

A couple weeks ago, there was a discussion on the local NPR station midday show (Mark Steiner) about pot, and one of the guests was someone associated with the ONDCP. She made the EXACT same argument that jane made in her earlier comment: That she refused to believe that medical science didn't have something better than pot, and therefore there was absolutely no need for anyone to use pot for any reason whatsoever. She didn't name any names of products, just the dogmatic assertion that there MUST be something better. This struck me (as does Jane's comment) as amazingly shortsighted. Do this mindset really intend to force people away from something that works for them, and down what could be a long, painful, expensive road, full of dead ends that don't work, unexpected side effects, and the possibility of NEVER gaining the relief you could get from a known quantity of pot, or opioid pain reliever? Really, what is the goal of this crusade? The illusion of 'doing something' about illegal drug problems that can be argued to have been exacerbated by the very act of making these drugs illegal?

I just don't understand this desire to throw out known, easy to obtain, well-tested remedies that appear to be effective, based on their misuse by others.

[Jennifer]

Jane is kidding, guys. Does the name "Juanita" ring a bell?

[Ruthless]

In the Koran, Allah instructs us to flagellate ourselves severely around the head and shoulders. It's a "character-builder," she says.

[Xmas]

Jane,

You know those drugs cause liver damage in general and internal bleeding in the stomach and intestines when taken orally right?

[poco]

Do not feed the jane.

Jane, honey: they're spelled (tho not pronounced) "opi-OID" and "inflamMAtory".

[Ruthless]

jane does not feal our pane.

[saw-whet]

Mr. Nice Guy, You put it very well, especially the rot in hell part. But I have had a thought for quite sometime and I think this is the time and place to express it.

A majority of the world's population, say 50-60%, want bad things to happen to others. The manifestation of this desire into action is nuanced and subtle to the point of being almost undetectable.

For example, making marijuana illegal is an outrage to a reasonable person, but to a person who wants Mexicans and Blacks extirpated from their community, it is simply another arrow in the quiver.

How about war for another example? Many of my conservative colleagues wanted to "kick the Iraqis ass.? Us against them. You don't want to kick their asses? You pinko fag! You're the enemy! Go back to France.

After a lifetime of mindlessly and cravenly accepting the anti-drug propaganda (for reasons we are all too aware of), the majority of people want opiates to be strictly controlled and are willing to make monsters out of the doctors who prescribe them. After all, it doesn't affect them and it never will because they would be a man and just take it. The weaklings who need the crutch of prescription pain killers deserve to suffer because they are not tough enough to take it. (I hope everyone here can see that this is sarcasm, otherwise there will be a lot of wasted words explaining what I hope is obvious.)

Sure there will be a lot of regrettable unintended consequences, but who cares. We are acting to the will of the majority. Bomb innocent civilians? Why not, lousy ragheads. Throw the Black kids from the other side of town in prison, destroy their lives? We don't care about them. Deny your dying father pain medicine? If he can't take a the pain, then that's just not my problem. You disgust me.

In short there's a lot of bad shit that happens and will continue to happen because we want it that way. Not consciously, but in a subtle, probably survival instinct sort of way. Ever hear the expression, ?I don?t care, just do something!? And it is not just USonians, it is everybody throughout all of time.

Just a skeletal explanation of a recent thought. Now, let the flaming begin!

[drew]

These stories always make me really sad.

The drug war has always hurt poeple more than it helped, but those people whom it hurt uniformly made the choice to participate in drugs, knowing full well that it was illegal, and knowing that the consequences were bad.

Now the warriors have moved on to try and prohibit those who are so ill they cannot move from receiving the drugs they need to function at the most minimal level. There really aren't words to described how evil and pernicious the drug war has become.

It was always bad for the government to try and legislate personal behavior on the premise that people were hurting themselves and should be stopped. But the minute that legislation started actively injuring third parties it became unconscionable. What reasonable person believes it is acceptable for the government to hurt me in order to keep John from possibly injuring himself?

[jane]

You know those drugs cause liver damage in general and internal bleeding in the stomach and intestines when taken orally right?

Yes, all drugs have risks, however opiods are extremely dangerous, much worse than NSAIDS and do worse bodily harm. Anticonvulsants like Carbamazepine and Valproic acid can relieve some types of pain withoud addiction.

People in pain need to learn to tougth it out. Pain is inherently good for the soul, it is evil to use opioid drugs except in terminal patients.

Most doctors prescribe Motrin for pain.

Anything that can help the police keep us all off drugs is inherently a good thing. I'm all for it.

[Joe Public of America]

Opiates are not any more addictive than many other legal and non-legal substances. For those that fear the addiction issue, read Jacob's book. Patients across the country are suffering due to the governments crusade to stamp out a tiny minority of opiate abusers. Its complete and utter bullshit. My mom is one of those suffering from a degenerative spinal disease that will soon leave her in a wheel chair. Her doctor fears the governments crusade will end his career so grossly underprecribes her. Instead of calling her to talk about my day or whatever, I hear how bad things are getting with her and how little she gets to do because of the pain.

She once told me that there might be something to the Death with Dignity Act in Oregon. That scares the beejesus out of me. She's not even 60 yet.

Damn the abusers, the government has to leave the doctors and patients alone.

[Lowdog]

I love it when jane/juanita argues like the puritan asshole in all of our heads! 🙂

[Ruthless]

"A majority of the world's population, say 50-60%, want bad things to happen to others."

saw-whet,
Thanks for the lead into a promo for anarchy.
See the harassment of the sex-offender in a subsequent thread.
Government is a vicious cycle: It reflects society's indecision. Sex-offenders should either be killed by government or left alone.
Citizens get frustrated by the indecision. They are always urging the government to "do something, even if it's wrong." And because there is no cost to this senseless thinking, it can build into tsunamis of opinon.
Anarchy, on the other hand, forces each person to say to themself: "If I feel strongly enough about something, I'll do it myself. I know I'll suffer the consequences. If it turns out I don't have the courage, then I'll just start keeping my mouth shut."

Government is like a game of Hot Potato in the sense that everyone wants to pass the buck, but continues to be frustrated with the outcome nonetheless. The potato could be nuclear.

[jane]

Now the warriors have moved on to try and prohibit those who are so ill they cannot move from receiving the drugs they need to function at the most minimal level.

Couldn't they just take large doses of tylenol and ibuprofen? It seems that that is the legal and safe way to control severe pain.

[jane]

Actually, I'd bet that opiates are often more effective at pain relief than mj and yet almost always more addictive (and thus mj is preferable in my mind, when it is effective).

There are safer and more effective drugs available by prescription than mj.

Ah well blame big pharma or blame nothing and just conclude the laws make no sense.

Laws are meant to protect society and when you break them you are endangering society. Drug use has numerous downstream effects on society and that is why they are illegal. Alcohol is legal because it has a long history of sfe use in western society.

[kac90b]

"Modern medicine has safer non-addictive medicines, such as NSAID anti-inflamitories and anti-convulsants." - Jane

"Couldn't they just take large doses of tylenol and ibuprofen? It seems that that is the legal and safe way to control severe pain." - Jane

Large does of tylenol will destroy your liver, Jane. Large doses of anti-inflammatories do not help non-inflammatory pain.

You are either an idiot/troll or never been in severe, chronic neurologic pain. I'm going with the idiot/troll theory.

[Seamus]

kac90b: As Jennifer pointed out yesterday, Jane is being ironic. The reference to alcohol having "a long history of s[a]fe use in western society" is only one of many tip-offs.

[kac90b]

Ooops. Sorry Seamus. My irony detector must be way off today. I usually pick up on it pretty well. Need to go take my meds.

[jane]

You are either an idiot/troll or never been in severe, chronic neurologic pain.

Suffering is good for you, tougth it out.

[Freedom]

Everyone is unsure about Janes intention primarily because the crap she is spewing is the standard line of all the people who know whats best for you. Its not that hard to believe a lot of people truly think that way because they are nothing more than conformist sheeple being lead by whom POLITICIANS.. The thought of ANY politician knowing whats best for me and demanding I agree in ANY regard of my life makes me feel as safe as a gerbil in the front window of a pet shop in San Francisco..

Things will not change until all the old politicians are out. Face it have you ever heard a politician admit they were wrong? Think they will suddenly admit they have incarcerated MILLIONS and spent BILLIONS to stop something they "feel" is wrong? Don't hold your breath! They can not admit to it after 30+ years or lies and propaganda. Just like Ted Kennedy couldn't admit he killed Mary Jo while he was drunk. How much time did he serve for that anyway? Oh thats right NONE! go figure huh! But still the sheeple listen to him and his type like they know something.

This is how I see it.

For Gun Control Nuts - I just hope in the event I am ever in a confrontation which is life threatening that the gunman shoots you first so I have a lil extra time to pull mine out.

Anti- Drug Nuts - All I can hope is that one day they suffer needlessly and live a long time suffering the whole while.

DEA - Rot in hell works for me..

Not until the people of this country wake up and purge the whole damn government Federal and State and even local will anything even remotely begin to change. Neither party has your interest in mind how many times will we elect the same do nothing but trample on our freedom and take our money to do it to us politicians and their parties? Just think in a mere 10 to 12 years we could replace ALL of them and get some sense back into our country. Throw in term limits and we might just get our country back.

So much is fubared I just wonder if its too late to change without a major uprising by the people. If elections can't bring the change we need then maybe we have to bring the change ourselves. Perhaps we can get the anti gunners to lead the way 😉

Free or Drug Free. take your pick because you can't have both!

[Larry N. Martin]

People in pain need to learn to tougth it out. Pain is inherently good for the soul,

By the same token, nobody should use air conditioning. Better to just sweat it out (I say this as I've had to put up with almost two weeks of 95 degree weather).
Nobody should use automobiles. Bicycles are good, walking is better. Walking everywhere gives you character.

But seriously, why should some drugs be considered evil, while others are not? Why shouldn't the informed individual be the one to decide which drugs they would prefer, what risks are acceptable to them?