War On Drugs = A War On Sick People and Doctors
Rick Bayer, M.D.
"Many doctors know little about pain control and even fewer prescribe adequate doses of necessary pain relievers..."
Policy Reformers come from many different backgrounds but share
the idea that the War on Drugs is a huge failure and causes irreparable
damage both within and outside of our national borders.
WoD has a serious and potentially deleterious impact on every American
because it directly restricts your physician's ability to provide
pain and symptom relief. Perhaps your family members have had difficulty
obtaining pain relief for chronic illnesses; or someone you know
has had problems obtaining relief at the end of life. Millions of
Americans have had such problems, it's a possibility for any of
us. The potential victims of the U.S. government's WoD include every
American who seeks medical care.
Narc and the MD
When I received my license to practice medicine from the Oregon
Board of Medical Examiners (BME), I was told that I could lose
my license if I was "too generous" with controlled drugs.
The BME then explained to me how to practice "politically
correct" medicine. Naturally, the question arises: who determines
what "politically correct" medicine is? The answer:
the federal Drug Enforcement Administration (DEA), a law enforcement
bureaucracy in Washington DC.
you can visualize a policeman in Washington DC determining how
much morphine your grandmother with cancer should get, then you
can understand what has always plagued me in my profession. When
it comes to prescribing controlled drugs, the cops at the DEA
have the final word.
effect is chilling. It makes scientific literature, the experience
and training of a doctor, and the predicament of the patient all
a few years in practice, it was impossible to avoid knowing doctors
who had been "busted" by the BME for prescribing opioid
drugs like codeine, morphine, and synthetic derivatives. Patients
with chronic pain were to be avoided like the plague and were
often referred from one doctor to another to try to stay ahead
of the threatening letters from the BME.
who read the science and pay attention to outcomes know that prescribing
opioids to patients in pain rarely leads to substance abuse. Unfortunately
such doctors are not "politically correct." At one continuing
education conference I attended, a DEA agent warned doctors not
to prescribe more than six weeks of any controlled drugs, regardless
of the predicament of the patient. But we all know that people
in chronic pain generally suffer for more that six weeks. What
are we supposed to do?
answer from the "experts" is mind-boggling. We're told
there is really no such thing as chronic pain. That is an outrageous
statement on the face of it, and our patients tell us differently.
is the paradox faced by doctors across this nation. We are told
to pay attention to what bureaucrats and enforcers have to say,
not to our patients. It's bizarre. What's wrong with providing
pain relief and improved quality of life when there is no chance
of substance abuse? The result of these policies is that patients
live and die in pain and doctors are too frightened to help, except
possibly in the terminal phase of illness.
Response to Repression
repression often does, the climate of fear fostered by the WoD
elicited a patient revolution that continues to evolve. In 1994
Oregon voters passed Measure 16, the Death With Dignity Act, to
allow mentally competent, terminally ill Oregonians to choose
to hasten an inevitable death. This was an indictment of the very
poor end-of-life care that dying patients routinely receive. Many
doctors know little about pain control and even fewer prescribe
adequate doses of necessary pain relieverseven at the end
of life. Therefore, patients have sought to remove these decisions
from the politically-tied hands of reluctant doctors, and placed
the decision directly into the hands of the patient.
year later, in 1995, the very important Oregon Intractable Pain
Act became law. It provided sanctuary from the BME (our "proxy
DEA"), allowing doctors to prescribe necessary intensive
and long-term pain control if the patient signed an informed consent
In 1996 the complications of a blood clot ended my career in the
private practice of internal medicine. It is life-changing to
lose a practice, but one can find opportunity in crisis. I now
enjoy doing volunteer work and am happy to no longer have to foster
a relationship with the DEA and the BME in order to make a living.
I can now be "politically incorrect" by speaking out
about how the WoD hurts patients and doctors. Speaking out before
would have meant risking my Oregon license to practice medicine,
and my federal license to prescribe controlled drugs.
of my first goals was to preserve the Oregon Death With Dignity
Act by being a spokesperson for the 1997 "No on 51"
campaign (51 was the attempted legislative repeal of Measure 16our
Oregon Death With Dignity Act). It is my opinion that the crucial
part of Measure 16 is the provision which puts choice into the
hands of the patient. This is why I oppose euthanasia but support
physician aid in dying. The important difference here is that
the patient is in control and must self-administer the barbiturate
under Measure 16.
consequence of Measure 16's passage in 1994 was to dramatically
spotlight end-of-life care in Oregon. In effect, it turned the
tables on the old paradigm. Not only did it suddenly become politically
safe to administer generous pain medications, but to opponents
of Measure 16 it became politically necessary to prescribe. Either
way, patients have been the winners because Oregon now consistently
leads the country in morphine prescribing (milligrams per person),
and in percentage of hospice referrals. Additionally, Oregon has
one of the lowest Medicare hospital death ratesi.e. folks
die at home with family and hospice instead of in the hospital
surrounded by machines and strangers.
these gains are in political peril. As I write this, Republican
US Senators (including Oregon's own Gordon Smith) are attempting
to pass a bill, misleadingly called the Pain Relief Promotion
Act, to undo the Death With Dignity Act that Oregon voters passed
Medical Marijuana Act
In 1997, a legislator from SE Portland, George Eighmey, tried
to get a hearing on a potential Oregon Medical Marijuana Act but
was denied the opportunity by Republican committee chair John
Minnis. Once again, the legislature had failed and, once again,
a voter initiative became necessary. In the course of doing a
great deal of research on the subject (culminating in my co-authoring
a book about medical marijuana), I visited patients in their homes
and listened to stories about the medical use of marijuana. The
research reminded me of cancer patients I'd met in my training
and practice who informed me that they were using marijuana during
chemotherapy to control nausea, pain and spasticity from nerve
damage. The inescapable conclusion of my research was that, once
again, federal propaganda was ignoring science while interfering
with efforts to provide pain and symptom control.
hope was that the Oregon Medical Marijuana Act would focus attention
on persons who were chronically ill, as the Death With Dignity
Act campaign had focused attention on end-of-life care.
1998 campaign for Medical Marijuana was intense. As a spokesperson,
I had to publicly face a "hired gun" (a former AMA president)
sent by the corporate pharmaceutical industry, as well as argue
against opponents such as Senator Gordon Smith, Multnomah County
Sheriff Dan Noelle, and numerous law enforcement officers who
predicted the end of America if our law passed. Vigorous opposition
also included the American Cancer Society, doctors from Oregon
Health Sciences University, VIPs in the Oregon Medical Association,
the BME, and other guardians of the status quo.
a brutal and exhausting campaign, Oregon voters did indeed pass
the Oregon Medical Marijuana Act (OMMA). Yet in spite of that,
lawmakers like Kevin Mannix (running for Attorney General this
fall) introduced legislation during the 1999 legislative session
that became law and took away some of the voter approved gains
from the OMMA.
OMMA modified Oregon criminal law so that a person who follows
the law can use the herb, Cannabis (marijuana), as medicine under
the guidance of his/her doctor. Currently, over 800 patients,
400 caregivers (growers), and 400 doctors participate in the OMMA.
The Oregon Health Division has a website that describes the program
OMMA can only provide an exclusion to state law and cannot impact
federal law concerning distribution of marijuana to sick persons.
Therefore, in spite of scientific evidence in support of marijuana
as medicine (see www.teleport.com/~omr),
we still have some obstacles to overcome before this important,
ancient, herbal medicine is truly accessible to patients.
care decisions are personal, and confidential and should be made
by the patient and a chosen personal physician. This means that
a patient should not be a victim of decision-making by the for-profit
insurance industry, by self-righteous self-appointed dogmatic
religious representatives, and/or by the political morality cops.
The BME should protect patients from unsafe doctors rather than
sanctioning doctors for providing legitimate medical relief.
is one recent bright note in all of this: Recently a doctor was
sanctioned by the BME in Southern Oregon for failing to give adequate
pain and symptom control to dying patients. (This is the first
and only time in U.S. history that such a discipline has been
meted out to a doctor, so it is too early to call this a trend.)
Against the WoD
Consumer/patient pressure is what is driving the improvement in
pain and symptom control in Oregon.
Oregon Death With Dignity Act forced us to look at quality of
care of terminally ill Oregonians. The Oregon Medical Marijuana
Act is forcing us to look at quality of pain and symptom care
in chronically and terminally ill Oregonians. Now the BME (in
the past considered the right arm of the DEA in opposing opioid
prescriptions and the OMMA) has finally recognized that under-treatment
of pain and suffering is also bad medicine. The cumulative impact
of these recent developments may be to improve the medical climate
for prescribing controlled drugs under the protection of the Oregon
Intractable Pain Law. As the medical climate warms to this more
enlightened approach, prescription of controlled drugs can reflect
good science and compassion instead of the misguided War on Drugs.
is a drug policy reformer? Is it the college student who is horrified
that he/she can't qualify for student loans because they got caught
with Cannabis instead of "just alcohol?" Is it the libertarian
who rightfully questions the ethics of a government that passes
prohibition laws to criminalize what one puts into their own body?
Is it the agnostic who questions why religious dogma should replace
our US Constitution when it comes to personal freedoms? Or is
it the person who visits the doctor with grandma and wonders why
doctors don't "do something" when it comes to treating
grandma's arthritis or her cancer pain?
is all of the above. No American can escape the tragedy of our
country's failed drug policy. America's War on Drugs is a war
on the American people and their doctors. Join the drug policy
reform movement because you care about others; because you care
about our society; and because you care about your rights and
future needs as a healthcare consumer.
"Rick" Bayer, MD, FACP lives in Portland, Oregon,
is board-certified in internal medicine and a fellow in the American
College of Physicians - American Society of Internal Medicine.
He was in the solo private practice of internal medicine in Lake
Oswego, Oregon from 1981-1996. He was a spokesperson for "NO
on 51" to preserve the Oregon Death With Dignity Act in 1997
and was a chief petitioner for the "YES on 67" (Oregon
Medical Marijuana Act) in 1998. He is a co-author of "Is
Marijuana the Right Medicine For You? A Factual Guide to Medical
Uses of Marijuana" (Keats 1998). He currently works with
two non-profit organizations, the Multnomah County Health Department,
and the Oregon Health Division to prevent childhood lead poisoning
Top | eMail Alternatives | Home