My father is 96. A month ago, he shuffled around the house, up and down the stairs, quite well by himself. Then, as he puts it, “I fell on my arse!” Oops! Compression fracture of the spine. Treatment: pain killers and bed rest. But, if he is ever to walk again, he must get up regularly, and spend two or three hours a day sitting in a chair. The doc prescribes hydrocodone–acetaminophen (Tylenol) with a touch of codeine. That doesn’t begin to control the pain if he sits or stands. “At my age,” says my father, “I don’t need to suffer.” So he lies there on his back, reading or playing games on his laptop.
Over three thousand years ago traders in the ancient Near East shipped opium packed in little jugs shaped like poppy capsules, with painted diagonal stripes to represent the slashes for collecting the resin. Opiates, including derivatives like codeine, morphine, heroin, methadone and oxycodone, are still the safest and most effective pain-killers known. People can use them for life with no more serious side effects than constipation. Yes, an overdose can kill you. But guess what? Two or three times the maximum daily dose of acetaminophen in hydrocodone can fatally damage your liver. And yes, opiates are addictive–for some people. So is alcohol–for some people.
The United States controls “drugs of abuse” with a ferocity rare in other western nations. The policy started with the 1914 Harrison Act, directed at Chinese opium-smokers. But the drug war as we know it began under Richard Nixon, and metastasized under Ronald Reagan. It’s what sociologists like to call a “moral panic”–a fear that undesirable groups somewhere are engaging in immoral behavior, and–BOO!–they might corrupt your children. For Nixon it was blacks, hippies and war protesters. For Reagan it was welfare queens and crack addicts.
Some moral panics die out, like the one about gambling. Remember Guys and Dolls? That was before states hit the lottery jackpot. But the drug war fills too many political needs. Because drug possession or sale is a victimless crime, it permits selective prosecution. Even though whites and blacks use illegal drugs at about the same rates, blacks are arrested, prosecuted and jailed at many times the rate of whites. Southern states don’t allow ex-felons to vote. As a result, in 2000, disenfranchisement of blacks in Florida gave the presidency to George W. Bush. Now the drug war has come back to bite him in Afghanistan, where black market opium funds the resurgent Taliban and Al Qaeda.
At home, the Drug Enforcement Administration keeps doctors under surveillance lest they over-prescribe strong opiates (Percocet, OxyContin) or worse, prescribe them to addicts. Pain specialists have been prosecuted, lost their licenses and even been imprisoned for careless prescribing. Doctors run scared. So if you have an elderly patient with a fracture–well, not a priority for pain treatment. (Yet all the DEA’s watchfulness didn’t stop Rush Limbaugh from filling multiple phony prescriptions.)
My father has set himself up with everything in reach of his hospital bed–laptop, printer, telephone, files–an office on wheels. Time to go now. He’s ready for his favorite diversion: clobbering me and my sister at internet Scrabble!