Thank YOU for clarifying what it was that you “must have” (originally) intended to mean. Perhaps (at times) we can all learn from the thoughts (however seemingly adverse) arising out of the humble minds other fellow human beings …

I leave you with the following (lightly embellished) adage (capitalized so that the whole world know that I am emphatically serious!):

“TRUTH (as often as not) “IS” (even) “STRANGER THAN FICTION”
.

Thanks for your kind words. I consider myself (first and foremost) a fellow human being, and (secondarily) a physician. The reason that I have some understanding for the shoes that chronic/acute sufferers of pain walk in has a lot to do with the fact that I myself have dealt with 28 years of chronic severe neck/head aches, have torn my left rotator cuff (4-6 months of excruciating pain) as well as my right rotator cuff (4-6 weeks of the same). In addition to any analgesia that (I pray) you folks may be fortunate enough to be allowed experience – make sure to (gently, but diligently) “keep moving” (exercise) such infirmities! The foregoing statement (in deference to all you “concerned professionals” out there) is “human” – and not “medical” – advice …

Being (roughly) your age, I have experienced decades of life as a stranger (being a civil libertarian and a fiscal socialist) in a strange land (of fiscal libertarianism and moral totalitarianism). Integrity is a hard term to define per se – however, we all can point to examples of its absence.

Make no mistake – it is important that folks who use opiates/opioids on a regular basis understand that they are a helpful adjunct to the essential practices of remaining active (in terms of regular exercise), as well as maintaining a healthy diet, in realizing and maintaining “wellness” where it comes to chronic pain conditions. There is no easy way to negotiate these waters, and no panacea in a pill that exempts one from these realities.

The problem (as I see it) is that out of the millions of sufferers of chronic pain conditions in our society, there are many competent adults who recognize and act upon the above mentioned realities – and are not imbeciles in need of constant paternalistic supervision by moral nannies (themselves often obsessed with maintaining a profitable “dependence” in its own right based upon relegating patients to a childlike status in order to sustain their own pre-eminence as “deciders” and “arbitrators” of human behavior).

I believe that the core problem surrounding opiate/opioid medications arises not out of pharmacological realities, but (instead) out of our society’s unique and misplaced obsessions with a judeo-christian “anti-pleasure” ethic that has arisen in last century (due to its privileged and entitled proponents in positions of social power, and their self-serving desired control over the minds of others), thus malignantly permeating and (falsely) distorting society’s discussions of what it means to be a citizen in a free and open society.

We (some, anyway) seem obsessed with (not only) owning the bodies of others, but also with the absurd and immoral premise of owning the *minds* of others. This is (in no uncertain terms) a “tyranny”, and (one finds) is always promulgated by those who stand to profit (whether by financial or moralistic means) from standing in the dubious role of paternalistic magistrate over the free will and choices of competent adults.

Your use of the term “opiophobic” indicates that you may be familiar with the thoughts of the person who coined that phrase (Thomas Szsasz, Professor Emeritus of Psychiatry, SUNY), who (also) sagely stated, “How can such paternalism on the part of the rulers lead to anything but infantilism on the part of the ruled?”.

Szasz (in his 1985 book entitled, “Ceremonial Chemistry: The Ritual Persecution of Drugs, Addicts, and Pushers”) draws a cogent and telling analogy between the age-old “theocratic state” and what he terms as the modern “theraputic state”. These parallels are as humorous as they are tragic – but do indeed spell-out what I have come to believe is the *real* story that drives today’s imbroglio:

Dominant Ideology: Religious/Christian = Scientific/Medical

Dominant Value: Grace = Health

Interpreters, justifiers, prescribers and proscribers of conduct and their ostensible aims:

Priests = Physicians
Clerics = Clinicians
Nuns = Nurses
Saving souls = Curing bodies and minds.
Heroes: Saints = Heroic healers
Heretics: Witches = Quacks

Ceremonies and Rituals:
Confession, penance = Psychotherapy
Holy Orders = MD degree.
Extreme Unction = Medical death certification.

Panaceas:
Faith = Scientific knowledge.
Hope = Scientific research.
Charity = Compulsory treatment.
Holy Water = Theraputic drugs.

Pana-pathogens:
Satan = Christian Scientists and others who defy the authority of medicine.
Blasphemy = Rejection of medical science and medical treatment.
Witch’s Brew = “Dangerous Drugs”.

Prohibited Items:
The Bible in the “vulgar” tongue = Drugs in the free market.
“Dangerous Books” = “Dangerous Drugs”.

Unprofessional Conduct:
Selling too many indulgences = Writing too many prescriptions for “dangerous drugs”.
Questioning the infallibility of the Mother Church = Questioning the infallibility of modern medicine.

Agency of Social Sanction:
The Inquisition = Institutional psychiatry.

Aim of Social Sanction:
Forced religious conversion = Forced psychiatric personality change.

Thus, the “great unwashed” stand trembling and helpless in the “Cathedral of Drug Avoidance”, praying that (self-declared) “Doctors of the Universe” will take pity on their humble souls as mere commoners, and dribble a few “communal biscuits” upon the “hoi polloi” in order to absolve them of their “sinful sufferings” for a few brief hours – until the pay-for-service “cathedral” opens once again for business in the morning.

In the Reformation, Martin Luther attacked the dominant Church of the day for just that – selling “indulgences” (charging monies in order to absolve them of their sins, and ensure their entry into “heaven”). This was, indeed, the practice and function of the (rhetorical) “Whore of Babylon” …

Feel free to draw your own parallels, but do not expect much more than outrage and despite from the “Church of Drug Avoidance” who decry that their service to the “King” (the almighty dollar, and/or their misplaced delusions of grandeur) exists for the sole (and sanctimonious) purpose of “saving you from yourself”.

For those who might ascribe to concepts of “original sin” (that humankind is, from the get-go, flawed and sinful, and in need of supervision from on-high) – consider that the “high priests” of the “cult of drug avoidance” are but *themselves* human (and perhaps in need of a bit of humbling from above, themselves).

Note: Don’t expect much more than (what they themselves term as) “a state of denial” from the “theraputic priesthood” should you confront “Simplicio” with the premise that the solar system does not, in fact, revolve around such mere humans as themselves. They broke Galileo’s spirit and imprisoned him for life for the high crime of using his head. In some respects (where it comes to the “cathedral of science” in the “age of reason”) little has really changed where it comes to human nature. The faces have changed, but the hymns remain the same …

Heretically Yours, DR …
.

My previous post stated that, “The (rhetorical) ’shoes’ that patients suffering (acute, and especially, chronic) pain stand in are quite different from those worn by physicians …”

Several statements made by “LastoftheZucchiniFlowers” (hereafter LOTZF) unfortunately reflect what I believe are patently unreasonable opinions combined with a troublesome sense of an imagined superhuman superiority that exists all too widely in the medical profession – and one that has served to engender and promote the public perception of arrogance, entitlement, and indifference in its members towards the very patients who pay for their services.

Such attitudes do little to counter Thomas Szasz’s statement that, “The War on Drugs is a moral crusade wearing a medical mask.”, as they are socio-politically strategic, and are not grounded in known pharmacological facts surrounding opiate/opioid medications for analgesia.

LOTZF: “When in training and studying the mysterious phenomena we call ‘pain’ I recall being taught the following maxim: Pain is what the patient says it is. This predates the 1-10 scale but still holds promise for the provider to comprehend what the pt. is trying to say.”

DR: OK. That sounds like a reasonably humble thought.

LOTZF: “I maintain that the ED is NOT the place for those with chronic pain to secure medication.”

DR: So, LOTZF, who made you King (or Queen)? It’s nice that your “loved one” is prescribed 90-day supplies of oxycodone in the amount of 20mg per day in order to address their pain. You seem to approve in the case of your own personal relative …

LOTZF: “… He NEVER needs to visit the ER …”

DR: That’s nice (but entirely anecdotal).

LOTZF: “… because his chronic condition, like all other chronic conditions, is managed by a physician who knows him long term … ”

DR: Similarly anecdotal. Not necessarily at all the case for many members of society. What causes you to assume that the rest of the world functions in a model that you construct relating to one particular person’s situation?

LOTZF: “… and knows he is NOT a drug seeker …”

DR: I think that I can (almost) hear the organ-music …

LOTZF: “… but rather a patient suffering chronic pain who needs and thankfully recieves proper treatment from a caring, knowledgeable physician/surgeon.”

DR: Well, its great that your “loved one” has managed to make such arrangements. Why does the rest of the world deserve less understanding, compassion, and care from the medical profession in general (including in the ER)?

LOTZF: “… Going to the ER for chronic pain management is unwise and a poor use of ER services.”

DR: I would wager that you would not yourself be so full of judgment and certainty were you a similarly situated ER patient in pain yourself. Why would you treat other human beings differently than you yourself would (likely) desire to be treated? Ever imagined life in *their* shoes? … Ever?

LOTZF: “… these ‘breakthrough’ events should be discussed with and managed by your pain specialist so that WHEN the weekend comes and he is ‘not in his office’ and the worse case scenario occurs, you are covered.”

DR: That makes nice academic textbook material – assuming that the patient is a seer who divines the future – and who has a physician who buys in (rather than raises a jaundiced eyebrow) to such prophecies of future events. Sort sounds like “DRUG-SEEKER” talk, would not you (yourself) say? …

LOTZF: “… Patients have a responsibility to anticipate their needs, since we know ourselves best and to make preparations for our needs.”

DR: Now we are *really* pushing the envelope of dis-credibility. Sounds like a world-class projection of blame for patients not being seers. Do *you* divine the future, yourself, LOTZF? If so, I guess you would know what the patient will or will not need in future, as well …

LOTZF: “… The disposition and empathy of ED are a direct reflection of misuse of their workplace.”

DR: Presumably a justification for a high degree of suspicion, condescension, and despite toward the patient on the part of the medical profession. This is the classic pathology of the mindset: “blame the patient – and charge them a bundle anyway!”. Such gushing empathy gives a lot of credibility to statements such as, “It’s amazing, the self absorption here.” (-Paynehertz).

LOTZF: “… And do not misunderstand, I am in full agreement that people in pain must have their pain alleviated – just don’t expect the ER doc on duty to be your patient when you show up there with your saga.” …

DR: What? This is like saying that ER physicians are beholden to a different oath – simply because they work in a complicated and stressful environment. Totally bogus.

The idea that a client would expect the ER doc to be *their* patient is a strange convolution that is emblematic of the veracity of my previously posted statement – that the prospect of patients noting what does, and what does not, address their (subjectively perceived, and thus non-reducible) experiences of pain, and correspondingly communicating their experience and wishes to the physician, presents a troubling threat to the physician’s sense of primacy in decision-making. This is about power, privilege, and self-absorption within the medical profession – and *not* about the patients (ostensibly) served.

LOTZF: “… the ER doc is NOT your doctor …”

DR: A patently strategic “dodge” – plain and simple. If ER doctors are not physicians, what are they? Inquisitors and torturers? If so, why does the patient pay far in excess of the amounts charged by other physicians? For suspicion, condescension, and indifference? Please.

LOTZF (referring to a “regular” physician that the patient either may or may not even have): “… He/She will help you – trust me.”

DR: This is not only a “dodge”, but is also a far-stretch (considering the attitudinal tone of your statements in general). How could/would you know these things? Insurance adjusters use the same tactics – but, do we believe them? Why should we believe *you*?

LOTZF: “… My uncle (mentioned earlier) has HIS pain doc’s home # but in three years he has NEVER called him at home. He says something about just knowing that he CAN is relief enough.”

DR: That’s nice, but (again) entirely anecdotal. Do your standards for “proper patient behavior” when experiencing pain *all* arise out of your uncle’s personal situation and experiences? For the sake of society, I do hope not …

LOTZF: “… Nice thought and good luck to you in your search for freedom from pain. Whether it be physical and/or psychic pain matters not – both types will sap life’s joy leaving hopelessness in its wake.”

DR: Your “cruel compassion” strikes me as right out of a Franz Kafka novel. Ever considered a profession as a writer of fiction? It looks like you (already) have made a good start.

LOTZF: “… Whatever you do, DON’T take so much medication that you stop breathing. Sounds silly but it happened EVERY NIGHT across America …”

DR: Sagely advice indeed (the bit about not killing oneself via overdose due to respiratory depression). Since it is clearly the tabooed opiates/opioids that bring forth the greatest swells of organ music and choir – why not note that the “theraputic index” (Lethal Dose / Effective Dose) of these substances used alone is *very high*, and safer than many, many other medications (including NSAIDs and alcohol, that any adult can purchase in any amount)!

LOTZF: “… NO DECENT PHYSICIAN wants to be mixed up in the drug overdose death of a patient they don’t really KNOW! …”…

DR: Or (I presume), the death of patients that they *do* really know! I do not advocate putting loaded guns in the hands of suicidal fools. But I think that your rhetoric appears as more strategic in serving your own personal interests and net financial worth first, with the well-being of patients taking (at best) the last seat in the back of a (rhetorical) “bus” full of “bozos” (except, of course, you).

Your polemics may dove-tail nicely with the “flavor of the day” hysterics surrounding doctors within our society scrambling to cover their own bureaucratic derrieres, have a profitable career, and a very nice life, etc., but – the pharmacological facts surrounding opiate/opioid medications do not support your claims, and more and more competent adults in our society see through the sermons and extreme unctions so commonly proferred by yourself and other physicians within our profession as a justification for denying patients adequate relief from pain.

Instead, these human beings see through the moral pontifications, gesticulations, and professional strategery to the unfettered “me-ism” that commonly drives such doctrines of the avoidance of these relatively non-toxic medications in favor of (often more toxic, and, interestingly, significantly more profitable) treatment regimens. Just who, then, are the *real* charlatans here?

The “DRUG-SEEKERS”, or
the “DRUG-WITHOLDERS” …?

It’s becoming rather hard to tell in these darkening ages …
.