The War On Drugs Can’t Be Won – But it

Can Be Lost!
Papers, articles, news shows, internet blogs, television series and just about every other
source of information in the United States all have something to say about the poor
condition of our health care system, and about the War On Drugs, but almost invariably,
they miss one huge, no, a monumentally gigantic elephant in the room, one that’s been
blocking the door to life itself for millions of patients for decades now: the abandonment
of as many as seventy-eight million of our population to abuse, misdiagnosis and
mislabeling, mockery, poverty, and the suffering caused by non-treatment of a deadly
disease that destroys it’s sufferers a piece at a time over many years: chronic intractable
pain. Patients in unending pain that is none of their fault are labeled “addicts,” “drug
abusers,” “malingerers;” they suffer these and many other cruel and inaccurate attacks on
their reputations, their self-respect and the simple human vulnerability of this huge
population of sufferers, the vast majority of which could be easily and relatively cheaply
treated, many even cured, is routinely denied by the very agencies who were created to
help such people! Far more often than not, if CIPPs (Chronic Intractable Pain Patients)
are treated at all, it is in the cruelest possible ways that deny the known, medically
correct, specific treatment for this scourge that destroys more lives than any other single
condition, and yet has been rendered invisible to the public because of it’s political uses
and profitability.

Based on the now-questioned “W.H.O. Ladder” that presupposes treatment of pain with
anything other than opiates is preferable, if it works, though at least they add that caveat,
though it is ignored by the U.S. government and medical community, requires that
doctors try the entire range of deadly dangerous NSAIDS, corticosteroids that cannot be
used continually without risking killing the patient, and then procedures known to cause
damage themselves as well as being extremely painful, like injections directly into the
spinal canal, all of this and more, before trying opioids. Then, when they finally get
around to an opioid trial, it is almost always found to be almost a “magic bullet’ that
brings the pain under control enough that the pain can begin to live again; as Dr. Alex
Deluca puts it, “It’s like watching a miracle – they almost literally ‘pick up their beds and
walk!’ ” But it only works if it’s done correctly, which almost never happens in the U.S.
“Correctly” requires the understanding that most pure opioid agonists, like morphine or
fentanyl, have no set ceiling dose, so the dose can and should be raised until the pain is
under control. It has been recognized by physicians who treat chronic pain that the
W.H.O. ladder is ideologically driven, not medically, and it requires forcing more
needless suffering on innocent patients who just want to stop hurting so much that they
cannot rest or function due to the pain. Starting on anything but the acknowledged “Gold
Standard” for treating unending pain is an act of cruelty that could easily result in the
further damage or even the death of the patient! Fears of death by respiratory depression,
a side-effect of opiates, have been greatly exaggerated even in the medical community.
Patients develop a tolerance to that effect so quickly, the amount per dose can be double
every second or third dose without ill effects, yet hospital patients writhe in their beds in
unrelieved pain waiting for an arbitrary amount of time to pass before they can have
another dose, and pain patients are denied all but the barest minimum of relief for years at
a time! Used correctly, opiates are the safest and most effective medications there are.
The problem arises when doctors, ignorant of the textbook standards, called the “Medical
Standard of Care,” as opposed to “usual practice,” attempt to dictate the dose or the
particular opiate or both without reference to how the patient rates the effectiveness of the
treatment, and without considering any changes in functionality. Patients, finding that the
opiates actually control the pain, often raise the dose themselves (called ‘unauthorized
dose escalation,’ which is considered a “red flag” for addictive behavior) in order to get
some cleaning done, to cook a meal for a change instead of eating out of a can or to have
meals prepared and frozen for when the meds run out, to socialize, to see children and
grandchildren they hurt too much and have too little energy for on the lower dose, or just
to go outside and remember what sunlight feels like. They choose to have this little bit of
life, and then to run out and suffer the pain and withdrawals (which can also cause
damage or even death) because of the too-low dose, rather than to have a tiny amount of
or no pain relief and no life on the inadequate dose the doctor insists on. This is little
different from having an anesthesiologist use the textbook dose of an anesthetic for an
operation and insisting that the doctor continue and cut the patient open even though that
particular patient requires a higher dose than usual and is still awake! It is sheer, needless
cruelty that has nothing to do with medical ethics or standards; there is simply no other
word that fits. There are books and papers referenced in the footnotes at the end of this
article that constitute the correct and current "Medical Standard of Care" that are detailed
and referenced for people in the medical field who want more detail and the specific
science behind current standards.

Far too often, the nurse at the doctor’s office believes she is protecting her doctor from an
addict and outright taunts and abuses chronic intractable pain patients, insisting that
“You’re already on a dose that should handle any amount of pain!” often publicly
humiliating and even blocking the patient’s messages to the doctor that s/he needs in
order to know how effective the current regimen is. This can cause a “chilling effect”
that leaves the patient afraid to complain or to ask for more or a different medication, so
the patient goes downhill and the doctor never knows why until the patient leaves to find
another doctor who might treat the pain better. Then, for the desperate patient, the whole
rigmarole just starts over again, and any progress is lost. The nurse’s taunt is also a
totally, medically incorrect statement. A regimen that handles the usual level of chronic
pain in a patient does little for pain increased by a bad day, by too much activity, by
another operation or by the condition getting worse, which is what chronic pain does
beyond a certain point, especially as the patient ages and if the pain has been ongoing and
poorly treated for many years or even decades. Many surgeons and PCP’s refuse to
prescribe additional medication for a patient who has just been operated on, erroneously
believing that the regular dose of opiates will handle the additional pain. This is not at
all true, and the patient is thus abandoned to unmitigated post-operative or other pain,
something most doctors normally wouldn’t ever consider doing! This is why
breakthrough medications are also prescribed – because humans are not simple machines
that never vary, and sometimes the pain breaks through the protection of the usual
regimen, which then needs to be supplemented by additional medication. Sometimes the
pain is worse than average, so that increased level also needs to be handled. This is also
part of the Medical Standard of Care. Another common error, especially in the hospital,
is that doctors assume that the recommended time period for a given dose to last is graven
in stone; too often the fact that they are working with human flesh, not stone, is forgotten.
Also forgotten is the fact that almost every numerical value that doctors deal with is an
average, and if they stick with that average, the vast majority of patients on both ends of
the spectrum are left out! In dosing, this means that almost all of a doctor’s patients are
either under- or over dosed! Thus, when a hospital patient says the pain is back and asks
for another dose of pain medication, s/he’s usually told by the nurse, “It’s only been two
and a half hours – you’ll have to wait until it’s been four hours,” or six hours, or whatever
the recommendation is, leaving the patient, again, to suffer needlessly in untreated pain.
If the pain is back, it means the last dose of opiates has been used by the body – it’s
gone! Giving another dose isn’t going to cause a problem any more than the first one did,
although the doctor might wish to consider a stronger medication or a larger dose if the
first one ran out that quickly. Abandoning the patient to unmitigated pain, however, is,
again, ignorant cruelty, and is not based on scientific fact – but it’s also “usual practice.”

Uncontrolled pain is a death sentence. It's a recognized disease that destroys nerves,
ruins the ability to rest and keeps the body permanently on high alert in the "fight or
flight" reflex, which was never meant to be continuous and permanent any more than a
car is meant to be run always at full throttle and nothing else, and for the very same
reasons – it’s a guaranteed way to destroy the body or the car. The pain will spread to
areas that didn't have it before, and stress-related diseases will begin to appear, like lupus,
type II diabetes, heart problems, high blood pressure and circulatory problems that lead to
stroke - it's a long list, and it’s deadly. Patients lose brain mass over time as well, they
age much faster than normal due to constant unremitting stress, and they become
physically deconditioned because it hurts too much to move unless it’s absolutely
necessary. They lose their families, their children, their friends, credit ratings and
possessions, and everything they've worked for over their working lives. They also lose
their own dignity, their self-respect and self-image, along with the ability to make
decisions or often even to relate to other people. The joy of life becomes a forgotten
thing of the past that seems forever out of reach. Even things as simple as lifting and
holding a beloved child, reading a book, staying clean and resting come to be so hard to
do patients lose them. They end up, finally, unable to care for themselves or to work
when the correct dose of the correct opiate plus a few adjuvant medications could return
many if not most of them to work, or at least to some independence. And like almost
everything else, all of these problems are erroneously blamed on drug abuse, even when
the patient demonstrably has had no medications and cannot get them because providers
have decided that they’re dealing with an addict! For CIPP’s, doctors are the gatekeepers
of their lives, of the foundation that they need in order to be able to live, and it’s a
terrible, hard thing for a patient who is aware that a few pills would allow a return to life,
to work, to usefulness, but is instead forced into suffering and immobility as their youth
and then what little they survive of their age is eaten away even faster than it would be
otherwise by the invisible iron suit of pain that they can never remove alone, complete
with cruel spikes to torture them that are hidden where others can’t see. They shuffle and
labor from place to place when they must go, and suffer the ignorant judgments, taunts,
impatience and abuse of healthy people who move, to them, as though they’re lighter
than air, as they once moved. Instead of continuing to titrate the medication that helps to
a useful dose, doctors too often stop at some arbitrary amount that they are comfortable
with, leaving the patient partially treated, but still in too much pain to do much but hold
onto the bare and fraying edge of sanity. The patient is generally told that the medication
isn’t supposed to control all of the pain, although why is never mentioned, probably
because there is no real reason, so the patient still suffers along, just a few invisibly tiny
milligrams, just thousandths of a gram, about the weight of a penny, of medicine away
from real functionality! Sometimes a reason like this is offered: “If you max out on these
opiates now, if you ever have an accident or get a terminal disease, the drugs will no
longer help you when you really need them!” It sounds perfectly logical, and is
completely untrue. Again, pure opiate mu agonist drugs have no severe upper limit. The
handful or less of doctors who have actually believed that and acted on it have found
themselves holding tearful patients who had forgotten what not hurting was like talking
about a miracle and have suddenly found themselves looking at the return of a human
existence they had thought was lost to them forever.

The fears of addiction are being massively exaggerated by Drug War propaganda that
even doctors buy into, and people who could be returned to the work force, or at least to
their families, instead are left in poverty, often homeless, and always suffering
needlessly. Tens of thousands of them become suicides when they are no longer able to
tolerate the unending pain and the loneliness, the mockery and abuse of family, friends
and even the medical community day in and day out along with the burden of the pain
and all of it’s consequences. Addiction only occurs in between one and three and a half
percent of the population, and it too is eminently treatable, along with the pain. The rest
of CIPP’s are thrown in with addicts by sheer ignorance. Physical dependence on a
medication is not addiction, else people on SSRI's, insulin, statins and many other
medications are also addicts - and everyone knows they are not! People who called these
other patients “addicts” would be laughed at as fanatic, medical Luddites. This cruel
treatment only happens to pain patients, who are stigmatized by perfectly normal and
reasonable behavior caused by the terrible need not to hurt anymore. Instead of proper
treatment in the face of such need and the reasonable request for help, patients are abused
by being given just enough of what they need to survive, but far too little to thrive.
People who do this to animals are thrown in jail for cruelty.

The drug-seeking behavior of a pain patient can be the same as the drug-seeking behavior
of an addict simply because they both want the same medications, but in the pain patient's
case it's behavior that is perfectly reasonable; they’re only asking for the medication that
specifically treats the medical condition they have. This behavior is called "pseudo-
addiction," meaning "false" addiction, and in the medical standard of care doctors are
warned not to mistake one for the other. One way to avoid that error is to watch the
patient’s reactions. Pain patients, unlike out-of-control addicts, get their lives back on
these medications; the addict loses control of dosing and desocializes, loses job and
home, where the pain patient enters society again, often tries to re-enter to workforce,
begins self-care again. The accusation that patients "continue to take the drug even when
it's causing harm" is true in the case of many addicts, but the "harm" people often mistake
for something caused by the medication CIPP’s need is actually due to inadequate
dosing. The patient is the only one who can, with a doctor's help, determine the correct
dose. Per the W.H.O., "The correct dose is the one that works." Opiates, unlike many
synthetic and semi-synthetic opioids like meperidine and methadone, have no toxic
effects and used correctly cause no damage. As it turns out, opiates, alone of all other
medications, protect the nerves that otherwise fire non-stop, causing tremendous pain and
in time damaging or even destroying themselves! The protection afforded by opiates can
give those nerves the rest they need, sometimes even allowing them to heal! In other
words, opiates can be a cure for chronic intractable pain! They do have side-effects,
most of which go away after a few days of correct use: itching, sedation, and after some
time using them, increased tooth decay because of thickened saliva, and in men, the
destruction in the body of testosterone, but all of these are easily treated, certainly far
more easily than death, an unavoidable side-effect of non-treatment! The respiratory
depression effect, often cited as a deadly and unavoidable effect of opiates, is also easily
dealt with. The tolerance for that effect builds very quickly - within a couple of doses,
and it builds much more quickly than tolerance to the analgesic (pain killing) effect, so
that dose increases can be almost geometric, being doubled every second or third dose!
The W.H.O. reports doses as high as three grams being effective and well tolerated, and
there is a long list of historical luminaries who used opiates all of their famous and very
productive lives, including a founder of Johns Hopkins hospital and the originator of the
modern surgical paradigm.

The Drug War itself is the cause of many if not all of the problems erroneously blamed on
drugs: the illegal and very dangerous street trade of drugs, the high street prices, the
availability of powerful medications to younger and younger children, and the frequent
overdosing or poisoning of users by unregulated manufacture of drugs by the untrained -
all of the criminality associated with drugs, in fact - can all be laid at the doorstep of the
War On Drugs. Now, unable to show any progress in the Drug War after nine decades of
criminalization, the DEA has taken to loud and flashy show-trials of compassionate
doctors who dare try to treat people in unending pain correctly, with legal medications.
They have used sheer muscle and a convenient (for them) interpretation of the Controlled
Substances Act (CSA) to destroy medical doctors who are doing exactly what they’re
supposed to do – treating patients with compassion and knowledge, helping them to
return to their lives, their jobs and their families, and the patients are caught in the
crossfire. This weakest, most desperate demographic that is stuck in agony and poverty
needlessly is also being casually destroyed by federal cops who have literally taken over
the medical field of pain management! Too often, patients who have been totally
abandoned by the medical community, sometimes in their hundreds or thousands when
the DEA destroys another pain clinic or doctor, have only two choices: to buy the drugs
they need to keep working or to simply stay alive illegally on the street if they can, or to
lose everything – job, money, family, home, even their lives. And course when they’re
caught, which happens often because these are not career criminals who know the ins and
outs of the street trade, all of the blame is placed on their shoulders, and on the drugs
themselves as if they can make choices. Ask yourself this, though: if you were a diabetic
and some religious fanatics managed to get insulin made illegal, would you allow
yourself to die due to this ignorance, or would you buy your insulin anywhere you could
get it? The obscene profits generated by the Drug War to corporations and government
agencies leads to the refusal of the government and these other entities to recognize that
literally all of the problems that are supposedly caused by the illegal drug industry, plus
the horrendous suffering and waste of the entire seventy-million soul population of
chronic intractable pain sufferers who range from very young children to older people,
can be corrected overnight by the simple expedient of following the Constitution and
removing or correcting the Controlled Substances Act and by decriminalizing drugs and
leaving them to the states to regulate as was done until the war on our own sick and
injured was morphed by PR (which stands here for propaganda) hacks into the mislabeled
but well-hyped War On drugs. As things stand, private prisons trading on the NASDAQ,
the Prison Guard's Unions, politicians looking for a safe plank for their platforms and
finding it in the Drug War, the DEA looking for tangible results to justify their ever-
increasing funding of what is over $20 billion a year (though Drug War total costs run
over $60 billion) and their unaccountable power to steal property (civil forfeiture is
included in their and in police department's budgets!) and abuse ordinary, harmless
citizens with no accountability, the DOJ uses unethical and too-often illegal tactics to
manufacture high-profile cases out of ordinary doctors who are just doing their jobs.
States and private prisons that get federal funding grants for warehousing harmless,
nonviolent populations of prisoners whose “crimes” had no victims, the addiction
treatment industry which is backstopped by the forced treatment of pain patients who are
not addicts and who cannot be "cured" by anything except the treatment of their pain
giving the industry an unending stream of patients who are forced to endure "treatment"
for the wrong condition ... There are simply too many agencies, industries and
individuals who gain too much sheer profit and power for them to just give it up willingly
and walk away from it. The money and power granted to the "Drug Warriors" to fight
this false and unwinnable War On Drugs will never be released voluntarily, as the Prison
Guards Union in California demonstrated when they spent $2.5 million to defeat a
proposition in California that would have stopped the incarceration of nonviolent drug
offenders and released millions now in prison for victimless crimes, which have no
business being made into crimes at all.

The War On Drugs is, in the end, regardless of the denials of politicians who count on
hyping it for votes, a war on the weakest and most vulnerable of our citizens: the old,
those who are too damaged to work and can find no treatment in our strictly for-profit
medical system, those abandoned by understandably frightened physicians, or those who
are ignorant and misinformed by the entire propagandized and victimized medical system
whose physicians are attacked by a Justice Department that is now so powerful that to be
accused is to be destroyed, as Arthur Andersen was, guilty or innocent. Any agency that
brags about a 98% conviction rate has to know that they are imprisoning a huge
percentage of people who are totally innocent! Nonetheless, they continue to lie, spin,
blackmail, misinform and attack our own helpless and desperately ill citizenry. There's
just no place else where they can gain that kind of money and sheer, almost
unaccountable power. The verdict is clear, and is increasingly being shown in study after
study: we can't win the War On Drugs, but we can lose it. We are losing it - by
continuing to permit the cruel and utterly needless destruction of millions of lives for the
profits and power of paramilitary police agencies and an often complicit judiciary who
only misuse it, creating an ever-widening circle of misery, suffering, poverty and death.
The money being spent of the War On Drugs would buy the treatment of all of those
seventy million people who suffer in unnecessary pain, as well as most, and maybe all, of
our other citizens who have been trying desperately not to get sick because the costs of
medical treatment and medication would lose them what insurance they have, or would
place any treatment totally beyond them simply because ordinary people generally don’t
have fifty- or a hundred thousand dollars for out-of-pocket expenses; it would pauperize
them, likely leaving them and their children homeless. These are horrible choices for
people to have to make, but they are left to us this way because they are dictated by
soulless corporations and government agencies whose sole motive is profit or more
power. These organizations are so large, layered and complex that the blame for the
suffering and deaths they cause never sits on any one particular pair of shoulders, but the
results bow the shoulders and crumple the already-damaged backs of the innocent
seventy million or more who are dying slowly, suffering all the way, for lack of care.

Truly, we clearly, demonstrably cannot win the War On Drugs, but we can lose it. And
we are. We have. It’s long past time to do something else.

More information on the failed and destructive War On Drugs can be found on Dr.
Alexander DeLuca's site and on the old PRN site at http://www.doctordeluca.com/ and
http://www.painreliefnetwork,org/ respectively. There is also an organization of
courageous retired and active police from various departments and agencies who have
seen the futility and the terrible destructiveness of the War On Drugs, and have dedicated
themselves to fighting for the end of this war against our own citizens, called L.E.A.P. –
Law Enforcement Against Prohibition, at: http://www.leap.cc/cms/index.php on the Web,
which I add here for any DEA or DOJ people who have doubts or want to know more.
There is a terrific amount of information available on these sites.

References on the medical standard of care:

1) Fine PG, Portenoy RK. A Clinical Guide to Opioid Analgesia. The McGraw-Hill
Companies. Healthcare Information Programs. revised 2004. (Available:
http://www.stoppain.org/pcd/content/forpros/opioidbook.asp)

2) Chronic Pain I and II by Brookoff (written in a Fam Pract journal:

Brookoff , D. Chronic Pain I - A New Disease? Hospital Practice;
Volume 35; Issue 7; 2000. (Available:
http://www.doctordeluca.com/Library/Pain/CP1NewDisease2K.htm, and,
Brookoff , D. Chronic Pain II -The Case for Opiates (Available:
http://www.doctordeluca.com/Library/Pain/CP2CaseForOpiates2K.htm) both
in Hospital Practice; Volume 35; Issue 9; 2000.

3) An Ethical Analysis of the Barriers to Effective Pain Management. Ben A. Rich;

Cambridge Quarterly of Healthcare Ethics, 9: 54-70, 2000.
Abstract: http://www.doctordeluca.com/Library/Pain/EthicalAnalysisBarriersPainTx2K.htm
Full text PDF: http://www.doctordeluca.com/Library/Pain/EthicalAnalysisBarriersPainTx2K.pdf
The Distortion of Medicine, the Standard of Care, and Medical Community Norms;
Dr. Alex DeLuca; War on Doctors/Pain Crisis; 2008-12-30.
 http://doctordeluca.com/wordpress/archive/distorted-confused-med-standards/
NOTE: These are offered as companion pieces that delineate
how the ethical practice of medicine has been distorted by the invasion of the
regulation of medicine by a police-mentality that is only trained to
see criminality with reference to drugs, and is not suited to dictate to physicians how to
treat their patients, or to states how to run the practice of
medicine!

4) From Dr. Alexander DeLuca: “The “Reasonable Physician” Standard. While drug
war prosecutors invariably attempt to confuse juries and journalists, and usually succeed,
regarding this crucial difference between the ‘medical standard of care’ and ‘community
norms of medical behavior,’ that difference is in fact very clearly drawn, as a matter of
both medical ethics and precedence in criminal law. As Ben Rich explains in “Medical
Custom and Medical Ethics: Rethinking the Standard of Care” (citation/abstract - full text
PDF):

“When credible evidence has been presented that not just a particular physician, or an
isolated, retrograde group of them, but a majority of the profession has failed to adopt
practices that would materially reduce patient suffering, courts may properly conclude, in
the tradition of great justices like Holmes and Hand, that a reasonable physician would
not practice in this way6emphasis mine)”

Ian MacLeod
August 27th, 2009
Activist PRN, Nonprofit, Nonpartisan, 501(C)(3) Corporation.
Veteran, Disabled, Chronic Intractable Pain Patient, 25 years
Oathkeeper.
Primum, non nocere!
Illegitimis non carborundum!