It feels like a large splinter jammed under my left thumbnail. From my thumb and forefinger, the skin burns in a strip up to my elbow. Recent shoulder surgery has left nerve damage, not uncommon. During the day, it’s a distraction; at night, much worse. Before bedtime, I swallow two 5 mg oxycodone. At 3 or 4 AM I jolt awake—my arm has turned into an alien serpent, its fangs sunk in my shoulder. I gulp two more oxycodone, chase them down with a Heineken, slap an ice pack on my arm, and browse the Financial Times until the pain fades.
Hail to the god Morpheus, who gave poppies to our ancestors! Used with respect, opiates still provide the cheapest, safest, and most effective relief for serious pain. The only side-effects are constipation (guaranteed!), and for some, a warm, floaty feeling, drowsiness, slight nausea, and in a small minority, addiction. But compare that with those expensive, non-addictive wonder drugs, Celebrex and Vioxx, that turned out to cause heart-attacks and strokes! Or even compare that with Tylenol, often combined with oxycodone to make Percoset. Tylenol causes liver damage and doses not much higher than recommended for pain. (That’s why I requested oxycodone straight.)
Why do we Americans have such a thing about addiction to pain-killers? Nicotine is much more addictive. Alcohol can be addictive. Also sex—see DSK. Also caffeine, Spider, and Nutella. It’s true our poorer addicts (unlike Rush) lead a nasty life, constantly worried about where the next fix is coming from, whether it will be adulterated, whether they will be arrested… But the Swiss, Portuguese, British, Australians, and others have long since shown that given access to cheap, clean drugs through special programs, opiate addicts can lead normal lives, and even kick the addiction. Moreover, such programs help keep drugs out of the black market and away from children.
I feel a chill reading the latest alarmist accounts of opiate abuse, with calls for crackdowns on doctors who overprescribe. Will I be cut off? A recent story in the New York Times describes the dilemma of emergency room docs faced with patients demanding opiates. How utterly degrading for all three parties: the patients with physical pain trying to persuade the docs the pain is real, the addicts trying to persuade the docs the pain is physical, and the docs who can’t easily tell the difference. It’s like the cops in Arizona, trying to decide if a brown-skinned individual might or might not be an undocumented immigrant. US opiate policy traces back a hundred years to a campaign against Chinese immigrants. Today, hundreds of thousands of Americans suffer inadequate treatment for pain, hundreds of thousands of low-income addicts live as pariahs, and many a dedicated pain-specialist doc faces prosecution, loss of license, and even prison.
I’m lucky. After three months, the pain is starting to recede. I feel awkward asking Dr. Martin, our family physician, for yet another prescription. As I hand the pharmacist $5 for a month’s supply, I worry that Dr. Martin will suspect I’m becoming addicted.
For more thoughts on illegal drugs, see “Economics of Illegal Drug Markets: What Happens if We Downsize the Drug War?” (2005), and “What Drives the War on Drugs?” (2011).
Always good to read your writing Polly. I hope you get better and can continue the fight against monopoly power in so many of the fields that America once led in. I am always surprised that the Health Olympics doesnt get more of a write up. Interesting to note they are promoting “The Spirit Level’ book on greater equality = a healthier society.
Onwards to the age of economic enlightenment!
The amounts prescribed are far more than just alarming. In 2010, the latest year of stats, New York doctors issued 22.5 MILLION prescriptions for painkillers. Consider that the entire population of New York, men women and children, is just 19.5 million, and you can see how hooked we are.
For Sure! I remember when terminal patients with 4 months to live were denied adequate morphine because they “might become addicts.” I read this in the NY Times in the 1970s – no kidding. For the terminally ill, one signs up with Hospice. They “control your pain”, but if you dig deep enough they let you take all the morphine you need. It means that you do not really need to relocate to Oregon – where you establish a residence and endure just 30 days. In some cancers, like Prostate where every bone in your body will be hurting worse and worse every day having the extra morphine that would be a blessing. For others who will live but must endure pain without end this “control” is a frightening prospect.
“Recent shoulder surgery has left nerve damage, not uncommon.” What? I am just a worker’s comp. insurance defense attorney. So I’ve only reviewed medical notes on maybe a couple of hundred shoulder surgeries and after care in the last two plus decades While it is possible, I’d call it uncommon and so in fact would the medical literature! Moreover, the intrinsic low risk is further minimized by proper patient positioning during surgery.
“I gulp two more oxycodone, chase them down with a Heineken,” REALLY? Drinking alcohol with oxycodone increases the risk of overdose and death related to narcotics. Surely, you read this warning on the label. By the way, “recurrent drug use in situations that can be dangerous”, e.g. oxycodone with alcohol, is sign of drug abuse. And taking them this way (with alcohol) increases the likelihood of withdrawal symptons.
There is nothing alarmist about the reports of opiate abuse and the existence of doctors who criminally over-prescribe.
Polly- You express yourself so compellingly. I hope that you feel better soon. lOVE, DEBBIE
I am in total agreement. Thank you for writing it.
Mike Curtis
Dear Polly,
I am devastated to learn of your suffering, and to learn this way. We have been close correspondents and collaborators for years now, and you have never mentioned your surgery or your pain. Stoicism is admirable, and there’s probably nothing I could do to help you anyway, and Tom is an expert on meds, but still I can empathize and let you know how much I admire your courage. I am such a sissie with a nagging toothache, so I have a quick root-canal and it’s gone, but it teaches me to appreciate the problem of chronic pain that you and others endure.
Probably the best therapy is to keep up your creative work, and your social and professional lives, as you do. One obsession helps overcome another.
With love and admiration, Mase