Few actions so perfectly combine stupidity and cruelty as denying pain relief to the dying because narcotics can be addictive.
While policy makers squander billions on an unwinnable war on illicit drugs, each year tens of millions of people around the world, including 4.8 million cancer patients and 1.4 million end-stage HIV/AIDS patients, suffer needlessly because they cannot get pain-relieving narcotics. “The impact of impaired access to these medications is huge,” notes the World Health Organization (WHO) – huge in terms of suffering and economic losses, when people are unable to work or care for themselves and others.
For 6,000 years before Marx called religion (for its ability to dull suffering) the opiate of the masses, the actual opiate of the people was opium. A potent analgesic, opium is derived from easily cultivated poppies. Commercializing this cheap and common commodity, 19th century pharmaceutical companies turned opium into laudanum, the tonic of choice for what ailed women, and then into more potent morphine and codeine. In 1898, Bayer marketed its supposedly non-addictive improvement, “Heroin,” named because the German lab workers said it made them feel “heroisch.”
Early attempts to regulate drugs – the Hague and Geneva Opium Conventions – were consolidated in the Single Convention on Narcotic Drugs, 1961. It set an international drug policy that focused on curbing abuse – to the detriment of promoting the availability of drugs that alleviate pain.
Countries need infrastructure, will, advance planning and funds to negotiate the treaty’s complex regulatory bureaucracy. Each country must estimate its need for morphine and other controlled medications and petition an international body so that authorized producing countries can grow and provide the requested drugs. “f a government does nothing to ensure an adequate supply and a functioning distribution system, [opiates] will simply not be legally available,” says Human Rights Watch, which views pain relief as a human right.
As with most suffering – the viewing of reality TV excluded – the world’s poorest countries bear the highest burden. While North America and Europe consume 89 percent of the world’s morphine, low- and middle-income countries get by on only 6 percent, despite having half of all cancer patients and 95 percent of new HIV infections. Thirty-two African countries have almost no morphine distribution at all. Benin, Senegal, Rwanda, Burkina Faso, Gabon and Swaziland get enough opiates for less than 1 percent of patients in need; Bhutan, Gambia, Egypt and Kenya supply less than 5 percent.
Despite an acute shortage of doctors – and no shortage of pain – nurses in most countries cannot prescribe morphine and pharmacies and hospices cannot distribute it. In Malawi, there are 100,000 people for each doctor. And even if they can afford treatment, Nigeria’s 150 million citizens have only one pharmacy authorized to supply oral morphine.
Many of America’s 25 million underinsured are also unable to afford or access commonly prescribed, brand-name pain meds, such as OxyContin, which can cost $600 a month.
The fear of addiction, shared by both patients and providers, has some basis. But few people treated for pain go on to be abusers, and far more – especially the elderly, women and less-educated and – endure preventable agony because they are under-medicated. Every year largely avoidable pain is experienced by 25 million people as a result of injury or surgery, by up to 90 percent of advanced cancer patients, by 80 percent of children dying of cancer during their last month of life, and by half of all people dying in hospitals.
It is not only fear but also greed that feeds the pain. Undertreatment results when drug companys promote profitable narcotic alternatives. Pfizer aggressively pushed its patented aspirin-like pain relievers (NSAIDs) over older, safer and cheaper opioids. In March, Dr. Scott S. Reuben, a prominent Massachusetts anesthesiologist, was found to have fabricated more than a dozen studies “proving” that NSAIDs, such as Pfizer’s Celebrex and Lyrica, quelled post-operative pain. It turned out Pfizer underwrote much of Reuben’s research from 2002 to 2007. We are left to wonder how many post-surgical patients were told to suck it up because corporate research showed they should not be in pain.