In November last year I wrote about the eighth anniversary of a ten-hour neurosurgery I had that has left me with chronic pain. I am in mind of that situation given two events this week: I just finished watching the Nurse Jackie series and pondering – before autopsy results – the passing of Prince.
The previous column went the way of promise and perils of technology. This post is about drugs. The drug industry, the drug trade, the worst scourge of this country, barring none.
Because my diagnosis was so rare (patient 13 in U.S. medical literature, 22 in the world), none of the doctors knew quite what to do with me. Soon as pathology came back an amyloid, the surgeon in Pittsburgh dropped me like a hot potato. The (excellent) clinic to which I went at Boston University focused on the underlying plasma cells disorder. My long-time general practitioner had the patience of Job as I went through numerous kinds of drugs in search of one that I would tolerate and that would be effective. The pain doctoral at the Strong in Rochester, who was a neurologist by training, ultimately said that alcohol was as good as any other analgesic, so long as I was careful, because it goes straight to the nervous system. Last month I made an appointment with an oral surgeon at Massachusetts General Hospital to see if botox treatments in that nerve, the right trigeminal, might calm things down.
Throughout the course of this medical odyssey I was prescribed innumerable bottles of oxycodone. In the immediate aftermath of the surgery, I gratefully took oxycontin but naturally weened myself as the most acute pain went away and I returned to Ithaca. The enduring chronic pain has never left me for a day, however. In the heyday of oxy, doctors gave it to me left and right. I took 6 or so tablets total. I could not stand the woozy nauseaus feeling. For a time I kept the bottles because the fear of the overwhelming pain I first experienced was so great that I wanted to be sure if I needed it, it would be there. But together with the mystery of the diagnosis, the lack of coordination among the physicans was such that I had bottles and bottles of it along with benzodiazepines, SSRIs, anti-seizure medications, prescription strength acetaminophen and ibuprofen all lined up in my bathroom cabinent. A couple of years later, when my younger son was reaching his teen-age years and having scores of his peers over at the house, I decided that this medication was a potential attractive nuisance. I got a Wegmans plastic bag and swept them all into it. If there were corrupt Ithaca City Cops, one has a big boat at the local marina with my name on it.
Nurse Jackie is a fictional series about a good Catholic girl from Queens. An excellent and devoted nurse, she becomes a prescription drug addict, as the story goes, the result of a legitimate prescription when her first born was a baby. The cleanliness of the drug – no nasty smoke, no caloric drinks – together with the balm for whatever ails her sets Jackie on a long course of addiction. Never mind some of the not-so-believable aspects of the narrative. How, for example, did she bypass detection while pregnant and delivering her second child? What is depicted as indiscriminate use of many different kinds of drugs flies in the face of her professional proficiencies. The core narrative all too closely resembles what headlines announce today: a wide-spread epidemic of pharmaceutical abuse that dove-tails with the explosion of heroin that followed in the wake of crack-cocaine.
I cannot begin to describe to you the disgust this reality brings up in me. Let it be know that I am no prude. Because “everyone was doing it,” I tried marijuana when I was 15. I snorted powered cocaine in college. I drink more than the daily recommended allotment for women of one ounce of alcohol a day. But I am also deeply sickened by watching generation after generation of young people lost to drug abuse. The promise liberals such as myself had for impoverished back in the 70’s has largely evaporated into the illegal drug trade. Not wanting to miss out on all that money, the pharmaceutical industry jumped on the bandwagon and began to pump out the opiates enjoyed resplendently now by the middle and upper classes. Just think: you can get really high and keep your figure!
The reflective part of me thinks karma. Banana republics and Middle Eastern haters of the United States get their revenge on America by letting it destroy itself from the inside. Just yesterday I heard a report on the BBC about how the People’s Republic of China — think the Opium Wars of the 19th century — has become a source of fentanyl, obtainable by mail order, along with pill machines that produce thousands an hour. A society with so much material wealth injects, snorts, smokes and swallows all of those blessings away to become just as emotionally desperate as the 3 billion people in the world who live on less that $2.50 a day. As a matter of social policy, this country is just as addicted to the notion of a free market and profit at all costs as they are to the corruption allowed to proliferate along side both the so-called legitimate pharmaceutical and the illegal drug trade. Where are the plaintiff lawyers who should be suing the pharmaceutical industry just as they did tobacco? At least their efforts would be an initial bulwark against the psychology of abusing prescription drugs as if it were okay. We can shift from a culture of punishment to treatment in our courts, and we should, but not much more will change until we understand and address the broader dynamics at play.
This post will not answer that cry. But cry we will continue to do so long as we continue to put our heads in the sand about this repugnant national tragedy and think, at least for the moment, not me.
UPDATE: New York Times editorial, dated April 25, Rethinking the Global War on Drugs.
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