By Polly Cleveland, on May 6th, 2012
Econamici: 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).
