What is a legitimate medical reason to prescribe an opioid medication today? For pain or addiction? Who decides which patients are worthy of treatment? This question is not just of academic interest. Any prescribing medical provider today must constantly live in fear that a law enforcement agent somewhere will disagree with the prescriber’s answer to these questions. On its face, it seems simple. If a patient has severe pain, a prescriber can treat that pain with medications approved for that purpose. The same for addiction. Simple, right? Not really. There is a fundamental disconnect between the way law enforcement sees people and the way good health care providers see them. In short, law enforcement hopes to find a reason to lock someone up. Making arrests gets them awards and promotions. It’s what they do. They look at people as potential targets of prosecution.
Physicians and health care providers, on the other hand, see these patients from a diametrically opposite perspective. In order to help them heal, we must see them as human beings. We must give them the benefit of the doubt. We must form a bond of trust. The forging of this bond is absolutely critical to successful medical care. As much as amazing advances in medical science have improved the life spans of the average person, the belief that your doctor cares for you, and is doing their best to help you, is absolutely critical to the healing process. How many times have we seen a technically proficient physician become absolutely estranged from the patient as a person? No one feels like they have received proper medical treatment if they get the distinct impression that their doctor does not care.
And nothing will preclude the formation of this bond more than physicians having to look at every patient as a suspect, as a threat, not just to the doctor’s practice, but to their very liberty. It is my absolute belief that not only should physicians see through a lens of humanity but that we must. We know from history where doing otherwise leads.
Physicians in East Germany and throughout the Soviet Union were coopted by the state to diagnose dissident and divergent thought as a sign of mental illness and a threat to the community. Declaring a belief in free speech was enough to get you thrown into a dungeon-like asylum and treated with terrible procedures like insulin comas and hypothermia, until most had indeed lost their grip on reality. In China today, if you need an organ and have the money, a matching one will mysteriously quickly appear, and physicians that have escaped that regime tell us that a prisoner somewhere, a person with hopes and dreams and family, consequently disappears.
We cannot allow our system to become more like theirs. We must not allow ourselves to be coopted into the current political panic regarding pain and addiction treatment. We must not be forced to be arms of the federal or state government, looking at every patient through a lens of suspicion. We must be allowed to do what we believe is best for our patients according to our education, training, and experience. Not according to the prevailing political sentiment or the opinions of law enforcement.
The war on drugs may have started off trying to protect Americans from the dangers of drug abuse, that statement itself is debatable, but it has clearly ended up destroying many foundational principles of our nation, through policies like civil forfeiture and mass incarceration. Does five grams of methamphetamine do more harm to someone’s life than a mandatory ten years in prison? Is the damage to a child’s life when they lose meaningful contact with a parent or caregiver of no value? These questions can reasonably be argued from both sides, but what cannot be argued is that physicians have an ethical and moral obligation to treat pain and suffering. The problem is that law enforcement has no such mandate. In fact, the U.S. Supreme Court ruled in Warren v. District of Columbia, 1981, that police officers have no specific duty to protect individuals. They can stand around laughing while teenage girls drown in a flooded car, as they did in St. Petersburg, Florida, in 2016, and not be prosecuted or even sued. Doctors and other medical professionals may clearly have a different set of ethical and moral obligations. But these obligations don’t protect us from those who clearly do not.
How do we get out of this morass? How do we extricate ourselves from the battlefield and start to rebuild? Sometimes, I think that all physicians should refuse to treat pain or addiction until the dictates of Ruan are enshrined into federal law, precluding prosecution, and not just providing grounds to appeal. As anyone caught up in the federal conviction system knows, the wheels of justice in America turn slowly and almost always in only one direction. There is no way to be made whole after you have been targeted. Everything in your life is attacked and destroyed. On the other hand, if we turn our backs on those suffering from pain and addiction to ensure our own safety. How are we any better than those physicians, now reviled by history, that participated, or just looked the other way, while human beings were treated as unworthy of the most basic medical care?
I am encouraged by the example of the White Rose committee founded in Germany in the 1940s. Not because things went well for them, but because they tried. This group, started by one professor and five university students, opposed the abominable crimes their country was committing, including the forced sterilization and even murder of disabled patients and the mentally ill. The names of Willi Graf, Kurt Huber, Christoph Probst, Alexander Schmorell, Hans Scholl, and Sophie Scholl should be engraved at the entrance to every institute of higher education in America. All were eventually arrested. Hans, Sophie, and Christoph were executed by guillotine four days after their arrest. Followed later by Alexander, Willi, and Professor Huber. I’m not saying that things are that dire here. At least not yet. But we are not on a good trajectory. I also want to mention Drs. Karl Brandt and Julius Hallervorden. A physician and psychiatrist respectively. They initially spoke out against the regime’s medical mandates, but then decided to go along with the flow. Dr. Brandt had played a key role in implementing euthanasia and medical experiments on helpless prisoners, and Dr. Hallervorden did also. Brandt was tried at Nuremberg and hanged, but Hallervorden was not put on trial, and continued his medical career until his death in 1965. I don’t know if anyone asked the last two doctors if surviving a few extra years was worth the betrayal of everything a physician should stand for. But it is a question we must ask ourselves today.
If we are convinced that our patient has severe chronic pain, do we not then have a legitimate medical reason to prescribe that patient a medication approved for severe pain? If we are convinced that our patient suffers from an addiction, can we not then treat them with medication and other therapies approved for that purpose? Without needing to listen for the boot against the door? I would argue that we have not just the right to do so, but an absolute obligation. I hope you will too.
L. Joseph Parker is a distinguished professional with a diverse and accomplished career spanning the fields of science, military service, and medical practice. He currently serves as the chief science officer and operations officer, Advanced Research Concepts LLC, a pioneering company dedicated to propelling humanity into the realms of space exploration. At Advanced Research Concepts LLC, Dr. Parker leads a team of experts committed to developing innovative solutions for the complex challenges of space travel, including space transportation, energy storage, radiation shielding, artificial gravity, and space-related medical issues.