Many of World’s Poor Suffer in Pain

September 10, 2007 1:15 PM

Drugs Banned, Many of World’s Poor Suffer in Pain "Millions of people die in pain because they cannot get morphine, which is legal for medical use in most nations." [Via TalkLeft.]
posted by homunculus (47 comments total)

We discussed this problem a while ago. The ban on morphine is one of the saddest (and most preventable) medical tragedies of the 20th century... and all because of politics.
posted by vorfeed at 1:22 PM on September 10, 2007

And Mother Teresa.
posted by fandango_matt at 1:25 PM on September 10, 2007 [2 favorites]

So I got an interstitial ad. (WTF NY Times? Gave up pretending to be respectable?)

Paraphrased from memory, as it's not showing again.

*Picture of a medicine cabinet in a bathroom.*
Can you find the drugs your kids could use to get high?
*Cabinet swings open, it's empty.*
Looks like they already found them!
Know what drugs your kids can use to get high. They do.
Parents. The Anti-Drug.


What a juxtaposition.
posted by TheOnlyCoolTim at 1:28 PM on September 10, 2007 [2 favorites]

Know what drugs your kids can use to get high. They do.

Yeah, because their school DARE program told them what to look for and exactly what kind of high to expect!
posted by Pollomacho at 1:39 PM on September 10, 2007 [2 favorites]

Can you find the drugs your kids could use to get high?

I sure can, in fact, I bought them all from junk email pharmacies for my own recreational purposes.
posted by mek at 1:45 PM on September 10, 2007

Damn, Tim, that's disgusting-- maybe they figured it out and fixed it!

I wrote about this for the NYT in 2005 here, in the context of how this would be a good use for Afghanistan's opium. I'm glad the Times finally is giving it front page, news attention.

This whole thing makes me sick. As Siobhan Reynolds of the indispensable Pain Relief Network has said repeatedly, in what other area of medicine are patients held hostage to police concerns and why should this be acceptable in any part of medicine?

I don't understand why we accept the idea that the risk of death is OK in taking many drugs (for example, long term use of drugs like aspirin and ibruprofen (Advil) kills more people than opioid overdose. they cause gastrointestinal bleeding at therapeutic doses-- at therapeutic doses, opioids cause constipation, which is eminently treatable, if a literal pain in the ass), but not the risk of addiction.

Especially when that risk for people without a past history is less than 1% and for patients in general, turns out to be under 4%. And, of course, while you can become physically dependent involuntarily, you cannot become an addict without deliberately ignoring physician advice.

So, it's OK to impose a risk that is involuntary (GI risks from NSAIDS like aspirin, liver risks from Tylenol) instead of a risk that you have to willfully misbehave to incur (addiction and overdose risk from opioids).

We'd prefer to have people die in screaming agony rather than let a few people get high. It's just... ugh!
posted by Maias at 1:46 PM on September 10, 2007

Even in the US of A, I remember all the hoops my father had to jump through to get the pain medication he had actually needed during his fight with cancer. I was young then, but even at the time, I knew that the "war on drugs" was a sham which only hurt people.

The fear of morphine addiction does not justify banning the use of perfectly helpful medication necessary for a tolerable life, and I bet any proponent of such a ban would turn around in a single heartbeat should they contract cancer. Of course, they'd turn it around in their head - "unlike poor black people in countries I'll never go to, I shall only use these drugs for their intended purpose - isn't it so lovely to be smarter than an African!"

That's the hilarious part, if you think about it, and I recommend you don't, because now my urge to kill is rising.
posted by Sticherbeast at 1:50 PM on September 10, 2007 [2 favorites]

Its their fault for being poor and sick.
posted by Avenger at 1:53 PM on September 10, 2007 [1 favorite]

Oh, c'mon, really: politicians, bureaucrats, corporations, and special-interest lobbyists with agendas must know better than impartial doctors about the choices people in pain should be permitted to make. It's just common sense.
posted by ZenMasterThis at 2:02 PM on September 10, 2007

because now my urge to kill is rising

Embrace that urge. It's your humanity trying to escape the prison we've all placed ours in.
posted by aramaic at 2:09 PM on September 10, 2007 [3 favorites]

Come on. Pain brings you closer to Jesus. Don't you want these people to go to heaven?
posted by mullingitover at 2:15 PM on September 10, 2007

I'm as much of a "Mother Theresa was an asshole" sort as your average drunken, Queen-hating British columnist, but is dragging that in here really necessary?
posted by Pope Guilty at 2:22 PM on September 10, 2007

I'd just like to point out that this is precisely the sort of story that most people will skim over in favour of reading about Britney Spears' poor dancing or Amy Winehouse tripping on uneven pavement. I think that was sort of what item was going on about earlier.
posted by chuckdarwin at 2:24 PM on September 10, 2007

Lots of Americans also suffer because doctors are afraid to proscribe opioid painkillers or risk prosecution. And even if they are willing to do it, they're not allowed to allow refills, so patients need to come back each week, etc. It's really awful.
posted by delmoi at 2:42 PM on September 10, 2007

*Picture of a medicine cabinet in a bathroom.*
Can you find the drugs your kids could use to get high?
*Cabinet swings open, it's empty.*
Looks like they already found them!
Know what drugs your kids can use to get high. They do.
Parents. The Anti-Drug.

I saw that the other day. Disgusting, not just the paranoid anti-drug message, but also the attempt to sow distrust inside of a family like that.
posted by delmoi at 2:44 PM on September 10, 2007 [1 favorite]

I don't know, I think there are some merits to the anti-opiate argument. I'm not saying I think sick people should be allowed to suffer, but they do come with a significant amount of risk. The article itself touched upon it:

“We are coming out of a war where a lot of human rights violations were caused by drug abuse.”

During the war, the rebel assault on the capital was called Operation No Living Thing. Child soldiers were hardened with mysterious drugs with names like gunpowder and brown-brown, along with glue and alcohol.

Might explain the hesitation in increasing the amount of opiates in circulation in some African nations. Here in the U.S., addiction to oxycontin, especially in teenagers, is a growing problem. Let them smoke pot, I say.
posted by emd3737 at 2:51 PM on September 10, 2007 [1 favorite]

During the war, the rebel assault on the capital was called Operation No Living Thing. Child soldiers were hardened with mysterious drugs with names like gunpowder and brown-brown, along with glue and alcohol.

Might explain the hesitation in increasing the amount of opiates in circulation in some African nations. Here in the U.S., addiction to oxycontin, especially in teenagers, is a growing problem. Let them smoke pot, I say.

Right, because all drugs are the same and opioids totally make people violent
posted by delmoi at 2:59 PM on September 10, 2007

Given that Mother Teresa worked toward implementing the aforementioned policies [to deny people pain medication], it absolutely should be mentioned. She's largely responsible for this outrage.
posted by fandango_matt at 2:59 PM on September 10, 2007 [2 favorites]

curse you, fandango!
posted by UbuRoivas at 3:05 PM on September 10, 2007

I'm starting to think that she did more harm than good.
posted by chuckdarwin at 3:05 PM on September 10, 2007 [1 favorite]

Child soldiers were hardened with mysterious drugs with names like gunpowder and brown-brown, along with glue and alcohol.

Actually, according to Wikipedia, brown-brown is cocaine that's cut with gunpowder; in other words, when they're talking about "gunpowder," it's not a slang term. It's actual gunpowder used to dilute the actual drug. Unpleasant.

And yeah, false analogy. Even a remorseless child soldier gets a lot less aggresive if he's got a nice opioid buzz going for him.
posted by infinitywaltz at 3:07 PM on September 10, 2007

repeated for emphasis: Let them smoke pot is the Let them eat cake of our generation.
posted by tehloki at 3:07 PM on September 10, 2007

I don't know, I think there are some merits to the anti-opiate argument. I'm not saying I think sick people should be allowed to suffer, but they do come with a significant amount of risk. The article itself touched upon it:

“We are coming out of a war where a lot of human rights violations were caused by drug abuse.”

During the war, the rebel assault on the capital was called Operation No Living Thing. Child soldiers were hardened with mysterious drugs with names like gunpowder and brown-brown, along with glue and alcohol.

Might explain the hesitation in increasing the amount of opiates in circulation in some African nations. Here in the U.S., addiction to oxycontin, especially in teenagers, is a growing problem. Let them smoke pot, I say.

That mysterious "gunpowder" drug is actually gunpowder - some people snort it, and no, that can't be very good for you. Brown-brown, as Nicolas Cage fans know, is gunpowder mixed with cocaine. Glue is glue, and alcohol is alcohol. None of those are opiates, and an opiate ban clearly hasn't helped prevent the godawful war, nor the bizarre parade of cheap, dirty, shitty drugs they pump into child soldiers to make them all the more crazed and pliable.

It's also worth pointing out that gunpowder, glue, and alcohol are all legal - it doesn't prevent their abuse. On the other hand, cocaine is illegal - that doesn't prevent its abuse.

As for teenagers using oxycontin - I'd rather they smoked pot as well, but going legally ballistic on oxycontin itself does not prevent its abuse, although it does certainly more than inconvenience those who may need it and those doctors who might wish to prescribe it. People who need strong and stable pain relief can't just take a few bong hits and get over it.

At any rate, the oxycontin thing is another issue entirely, albeit a related one. Morphine remains to be a necessary drug to treat severe pain, and it is pointlessly cruel to deny it to those who need it - especially so seeing as how it's a perfectly normal part of First World medicine.
posted by Sticherbeast at 3:07 PM on September 10, 2007

I read a good journal article recently, which I can't find. It was ostensibly about the Afgahni poppy crop, but gave a good history of opium use in the Middle East. During the 19th c. a British journalist went to present day Iran to look into opium use. He described recreational use exactly as alcohol is used in Western Europe, most of the population is fine with it and only a small amount regularly abuse it. This addiction profile is interesting in that it counters the notion that opium is an addictive drug like none other, and it only takes time until one goes from popping a Vicodin to injecting heroin after robbing a liquor store.

It seems with the current international framework we have, the poorest countries and the sickest people seem to get the short end of the stick. Take for example, Afghanistan. I doubt anyone would seriously argue that they would be worse off if opium cultivation was legal and traded on an open bourse. This is a nation so economically stunted, they do not have any manufacturing, trade or agriculture sector to speak of. Legalizing and regulating the trade would certainly go a long way into improving the conditions amongst the poorest farmers instead of taking the short-term approach of eliminating the poppy crop only marginally for a growing season. For some reason I am more concerned with radical Islamics gaining territorial power than some junkie shooting up in Needle Park.

I don't think the solution is as easy as legalization across the board, but there is a definite upside to changing our drug policy drastically. I am all for an aggressive campaign on educating a populace, punishing those who abuse drugs and putting in place restrictions on access. Contrary to popular opinion, drug and alcohol use declines rapidly as a society becomes wealthy and better educated. One only needs to look at the "Gin Lane" drawings of Industrial England to realize that we've come a long way and may be reaching the Platonic limit for curbing abuse (that is that a certain segment will always abuse and even exponential steps to curb abuse will be continually less and less effective).

Also, it is sort of good news that lifespans in Africa are reaching the point where chronic diseases and post-pubescent diseases such as cancer are becoming more prevalent. It shows that populations are at least living past their twenties.
posted by geoff. at 3:08 PM on September 10, 2007

It's also worth pointing out that gunpowder, glue, and alcohol are all legal - it doesn't prevent their abuse. On the other hand, cocaine is illegal - that doesn't prevent its abuse.

It is also worth pointing out that historically, the military has encouraged or at least tolerated the use of drugs to increase efficacy. See "Dutch courage" and the Meso-American use of mushrooms and other stimulants. The problem is not the availability of drugs, but the human condition.

As for teenagers using oxycontin - I'd rather they smoked pot as well, but going legally ballistic on oxycontin itself does not prevent its abuse, although it does certainly more than inconvenience those who may need it and those doctors who might wish to prescribe it. People who need strong and stable pain relief can't just take a few bong hits and get over it.

I stated this in another thread, but model studies and ecological reality have both shown that given a choice, society overwhelming choses the less harmful alternative. The economics of the black market changes that, but there's a reason why beer -- at a measly 5% ABV -- outsells liquor.
posted by geoff. at 3:15 PM on September 10, 2007

The economics of the black market changes that, but there's a reason why beer -- at a measly 5% ABV -- outsells liquor.

Here I am just moved to Pennsylvania and when I want a drink at night I've pretty much turned to the hard stuff, because the PA gov't DOES NOT WANT that I should buy beer in any form besides cases of Natty Light or paltry selection of random six-packs (two at a time only!) at NYC bodega prices. At least it's an opportunity to learn more about Scotch and Irish culture.
posted by TheOnlyCoolTim at 3:22 PM on September 10, 2007 [1 favorite]

It would be nice if people were as excited about banning production of weapons as they are about preventing people from receiving medicine.
posted by mullingitover at 3:48 PM on September 10, 2007 [4 favorites]

I dunno, mullingitover. There's a beautiful symbiosis between the world's two largest markets - arms & drugs - whereby the war on drugs pushes up the black market prices enough for the drugs to fund the war on people. Banning certain substances is actually a crucial factor in maintaining a healthy market for weapons, so it would be economic disaster to make drugs easily available at the same time as making weapons scarce.
posted by UbuRoivas at 4:34 PM on September 10, 2007

mullingitover writes "It would be nice if people were as excited about banning production of weapons as they are about preventing people from receiving medicine."

While I do agree with the principle on some level, the two are related. Banning production of weapons or the consumption of recreational drugs does not make them go away. It does make the assumption that people cannot be trusted, inherently. And it does make them go through different channels, but people will get their drugs or weapons if they really want them, creating and stimulating black markets and criminal economies. Both are simply attacking the symptom of problems that run deeper than the existence of weapons or drugs. And dealing the symptom doesn't solve the problem, so banning either is doomed to failure in the long run.
posted by krinklyfig at 4:41 PM on September 10, 2007 [1 favorite]

Drug misuse doesn't cause human rights violations. Drug prohibition absolutely has (Consider: racist law enforcement in all its many forms, executions of dealers and users in China, Thailand and Iran, 10 zillion other civil rights violations-- what one Supreme Court Justice has labeled the drug war exception to the Constitution).

And of course. the vast majority of violence associated with the drug business is associated with the trade-- ie, with an unregulated free market in a high-demand product-- not pharmacology. Lots of studies on this from crack in the 80's, as I recall, trade-related violence was something like 80% of it.

While misuse of drugs like cocaine, amphetamine and alcohol can enhance pre-existing violent tendencies, it does not create them (and opioids and marijuana tend to reduce violence-- though withdrawal from opioids can create crankiness).

The vast majority of violent, addicted criminals were violent criminals *before* they were addicts. And the majority of addicts are *not* violent.

Those who argue that we need to keep drugs out of the hands of dying poor people in pain because they will become scummy addicts and run amuck are flat-out, 100% wrong. You don't see pain patients running out robbing people once they get "hooked" on drugs-- you see them go back to suffering if you cut them off, you see them function well if you prescribe appropriately.

And remember, the addiction rate amongst pain patients is just under 4%-- 96% do not become addicts even when given high doses of things like Oxycontin. Addiction doesn't reside in a drug, but in a person.

Remember, too, that the United States had a completely unregulated market full of opium and cocaine available OTC for much of the 1800's. Most of the opium addicts (actually laudanum, a morphine derivative) were middle class housewives.

We didn't illegalize drugs till we began to associate them with Chinese people, Mexicans and African-Americans and the fear was that they'd use the drugs to rape our pure white women. Although there absolutely were safety concerns about unlabeled drugs and unscrupulous marketing and varying dosages, the main thing that drove-- and still drives-- our wars on drugs is racism.

and it's sickening to me to see Africans perpetuating this racist nonsense on themselves, clearly unaware of the history.
posted by Maias at 4:49 PM on September 10, 2007 [6 favorites]

p.s. citations available on request for the research backing the above post.
posted by Maias at 4:51 PM on September 10, 2007

Banning production of weapons or the consumption of recreational drugs does not make them go away.

That's crap. When has the production of weapons ever been banned? The vast majority of weapons in the world today were legally produced.
posted by lupus_yonderboy at 4:54 PM on September 10, 2007

Maias writes "Addiction doesn't reside in a drug, but in a person."

That's a very important point. Doctors who deal with pain management know that everyone - everyone - will become physically dependent on opiods if used for long-term pain management. However, very few will become addicted. If stopping opiods, what's done is tapering off of the dose so that the patient doesn't go "cold turkey" and go into withdrawals. Even though this is a possibility, it doesn't mean someone's addicted. After the ramping down, the vast majority of people continue without addiction issues. So even physical dependence does not equal addiction, and dealing with dependence is a given in long-term pain management therapy.
posted by krinklyfig at 4:59 PM on September 10, 2007 [1 favorite]

lupus_yonderboy writes "That's crap. When has the production of weapons ever been banned?"

So, where's your evidence to the contrary?
posted by krinklyfig at 5:00 PM on September 10, 2007

[quote]I don't know, I think there are some merits to the anti-opiate argument. I'm not saying I think sick people should be allowed to suffer, but they do come with a significant amount of risk. [/quote]
Everything comes with a degree of risk it's just that the risks we're familiar with don't excite us while DRUGS!! do. Driving a car is pretty dangerous, so is taking any kind of medication you haven't taken before- you could have a reaction and keel over. People live in New Orleans and on the slopes of Mt Vesuvius. People wrestle alligators. The important thing is to keep it in perspective, because otherwise you turn into my mother and god knows, you don't want to do that.
posted by fshgrl at 5:22 PM on September 10, 2007

lupus_yonderboy writes "That's crap. When has the production of weapons ever been banned?"

So, where's your evidence to the contrary?

Why do I need evidence to the contrary? Someone makes a ludicrous claim -- surely it's up to them to back it up with some evidence, no matter how tenuous?

I searched for various terms, like "bans on weapons production" and found no evidence of anyone ever having tried this on any sort of serious scale. If you're going to claim this exists, you have to demonstrate it somehow -- you can't just make shit up and then challenge me to prove it isn't true.
posted by lupus_yonderboy at 5:44 PM on September 10, 2007

delmoi writes "Right, because all drugs are the same and opioids totally make people violent"

Probably too nuanced of an argument for the poor citizens of Sierra Leone.
posted by Mitheral at 5:50 PM on September 10, 2007

So, where's your evidence to the contrary?

Krinklyfig, it's impossible to prove a negative. In discourse it really is up to the person making the positive statement to prove it.
posted by orange swan at 5:51 PM on September 10, 2007

Really? Prove it.

(sorry)
posted by UbuRoivas at 6:45 PM on September 10, 2007

More Painkiller Hysteria in Florida
posted by homunculus at 7:09 PM on September 10, 2007

Drugs are probably the most insidious form of mind control because it bypasses the relatively weaker thought reform of religion and goes right for the virtual slavery through economic control. When people become aware of their problem they sound like Rush Limbaugh in their self-righteousness, defending their hidden fantasy state indirectly, which is a clue to their inner conflict. Reality is what they fear, and like all cognitive dissonance, they must convince others that reality isn't credible, in order to convince themselves. Drugs make it easier for them to do both.
posted by Brian B. at 9:29 PM on September 10, 2007

Lee L Mercer Jr? Is that really you?
posted by UbuRoivas at 9:38 PM on September 10, 2007 [1 favorite]

They should just huff their own shit gas.
posted by cellphone at 5:41 AM on September 11, 2007

.
posted by wires at 9:33 AM on September 11, 2007

Also: erupting out of her breast like cauliflower?

Jesus fucking Christ.
posted by wires at 9:34 AM on September 11, 2007

Japanese Slowly Shedding Their Misgivings About the Use of Painkilling Drugs
posted by homunculus at 2:14 PM on September 11, 2007

In India, a Quest to Ease the Pain of the Dying
posted by homunculus at 2:15 PM on September 11, 2007