Living with Pain: J’Accuse!

Living with Pain: J’Accuse!

Philip Seymour Hoffman

Philip Seymour Hoffman

When I first heard of Philip Seymour Hoffman’s death, I was angry — angry at him, angry that he could be so dumb, angry that he could take that sublime talent and shoot it into his brain never to be seen again.

But then I dismounted El Stallion, my high horse, and remembered the hundreds of men and women who crept like criminals through my office at the Salvation Army Family Services in Chicago every morning after being released from the overnight lock-up.

To a person they were crushed homeless drug addicts and alcoholics, sometimes both, and all mentally ill: The parade of the undead.

Heartbreaking.

There was so little I could do for them. They wanted “car fare.” They wanted to pool their money from me for a fix, for a bottle of Mad Dog 20/20, anything to quiet the voice of craving ravaging their synapses.

Hoffman’s death to a likely overdose of heroin is a tragedy for him, his family and friends, and a loss for all who cherished his work.

And now, without skipping a beat, his life and death are being sensationalized on TV, radio, internet and the printed press. All the grisly details of finding his body, the spike in his arm, dying alone in the squalor of his bathroom, the packets of heroin found, and on and on.

On the front page below a distorted, haunting picture of the actor, The New York Times weighed in with the breathless headline, “Hoffman’s Heroin Points to Surge in Grim Trade”. It’s the usual breathless story about the increasing use of heroin, the rise in related crime and drug factories, and the growing number of heroin overdose deaths.

Of course, there were the usual statistics and the usual suspects — shifty men and women working their trade in dealing narcotics.

But worst of all was the framework within which his story was told: These drugs are illegal. Therefore, those taking them are criminals.

Carte_jaccuseWhich leads us to the distorted sphere of law enforcement standing in for a medical, psychological and social problem. We stand dumb before it as hundreds of thousands of cold dead fingers point at us with one voice chanting: J’Accuse! J’Accuse!

I’m saying nothing new by saying the entire war on drugs is a colossal failure, with an outrageous loss of resources and loss of life.

Around this deadly, stupid failure has grown a deadly, horrible “treatment industry” of dubious results. When the main premise of the War on Drugs is criminality, then the treatment is based on the false assumptions of criminality and prohibition.

If experts think cancer is caused by bad blood, leeches can’t be far behind.

Our prisons are filled with the mentally ill, minor drug offenders, and people with addictions. Our entire legal system has been perverted by this War on Drugs and it’s done irreparable harm by exporting its false assumptions into the healthcare industry.

Do we really want the police, prosecutors, jailers, judges and lawyers to be the front-line of treatment for those seeking medical care for addiction? Following that logic, do we want “addiction specialists” steeped in this model providing “care” for those seeking help?

In the New York Times reporting on Hoffman’s death was a quote from Andrew Kolodny, MD, an expert on drug abuse and founder of Physicians for Responsible Opioid Prescribing (PROP). The reporter turned to him for a quote and the ever ready Kolodny lamented that once the opiate genie is out of the bottle it’s hard to put back in.

This handy quote fits Kolodny’s narrative that the overprescribing of opioid medicines will lead to the usage of other dangerous drugs.

800px-Injecting_HeroinDr. Kolodny is a relatively young man and perhaps he and others like him in the drug abuse industry have either not read or have forgotten their history. Forty five years ago there was a terrible outbreak of heroin abuse that coincided with the winding down of the Vietnam War. That outbreak had nothing to do with opioid medicines.

And herein lays the problem: The choice of drugs to abuse is caused by many factors; societal, psychological, warfare, economic decline, income inequality, supply and demand for drugs, and the presence of highly organized cartels with sophisticated marketing and delivery systems.

The problem for people with pain is that we have been singled out as the gateway through which opioids pass. Once opioids leave the medical sphere they become illegal drugs, making those who take them criminals.

Patients can become criminals when they become addicted. Instead of being able to truthfully tell their doctors about their substance problem, they have the very real fear of entanglement with the legal system and being labeled a criminal.

Even when following our doctor’s instructions faithfully, we are treated suspiciously — as if we are already criminals. This suspicion has made getting effective, timely treatment nearly impossible in some states. Why? The War on Drugs!

We need to decriminalize all drugs. Regulate and distribute them professionally with medical care. Tax these substances to help pay for the services. We will see, as some European countries have, that crime and overdoses go down and employment goes up.

Our current system is built on moralizing, destruction and incredible numbers of needless deaths.

Bluntly put, our drug treatment system needs dismantling, as it is quite simply a sham that enriches some while reigning horrible destruction around the many.

We need to turn to countries such as Portugal to see how to step away from our wrongheaded assumptions and poor service to a system that eschews criminality, courts and prisons for those in need of medical help.

The War on Drugs must end.

The War on Pain Patients must end.

Mark Maginn

Mark Maginn

Mark Maginn lives in Chicago where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog “Left Eye Blind” can be found here.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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There are 21 comments for this article
  1. a at 2:38 am

    Thanks for finally talking about > Living with Pain: J

  2. ginbug at 1:54 pm

    It was so sad to hear this great actor passed away needlessly & was SHOCKED to read so many coldhearted comments that it was his own fault & deserves no sympathy!
    It wasn’t like he died from cancer or a heart attack as those deaths are the ones that deserve sympathy, not some over paid, rich junkie!! WOW!!
    While, yes he made the choice to start using drugs; but the resulting addiction was not his choice as he now has a medical illness.
    How is he ANY different than someone that chooses to eat pizza, steak, & deep fried everything, dies of heart disease? After all, we choose to eat things that we know are bad for our health & lead to all kinds of illness?
    Dr. Kolodny is no expert in anything, except putting out biased, unfounded, unstudied, & down right wrong info!!! He misleads people about the “epidemic of pills” & the dangers they pose! If it were left up to him hardly no one would be able to have any kind of quality of life as he does not even really believe that most chronic pain conditions even exist & that basically only those dying of cancer should even be allowed opioids!
    The meds he gives along w/ treatments he and interventionist pain docs push are FAR more dangerous & the catastrophic damage they do is HEARTBREAKING!!
    Opioids on the other hand, when used as directed & for the proper legitimate patient, are some of the least damaging meds. out of all meds on the market! This is because our bodies already makes virtually the same endorphin. This is why we can become tolerant to it.
    It is not as easy as so many think to overdose on opioids if that is all they take & have a tolerance. It is VERY unlikely that Mr. Hoffman died from heroin. What actually killed him was that he mixed in another med. or he had not taken any kind of opioid for quite awhile which lowered his tolerance and therefore he tried to take the amount he used to take when he had a high tolerance.
    The stats that dr. kolodny & many others like to use to justify their “epidemic” is also misleading! They claim 16500 people die each year due to od on pain pills! 1st off it seems like a huge # until you compare it to other cause of death stats! Like 2nd hand smoke kills 40,000, otc pain meds. kill 45,000, 3000 arthritis patients die do to aspirin, 150,000 die from pharmacy mistakes & the biggest #1 killer is obesity which kills more than 300,000+ every year! So where is all the attention, outcry, & over reaction to stop these EPIDEMICS, that are MUCH more deadly than rx pain pills?

  3. John Quintner, Physician in Pain Medicine at 10:53 pm

    Myron, with respect I must plead “not guilty”. To quote from Mark’s article above: “Our current system is built on moralizing, destruction and incredible numbers of needless deaths.”

    Without any reservation I agree with you that the writings of the New Testament cannot be blamed for these current day problems that are staring us in the face.

    So wherein lies the blame for a situation where “Patients can become criminals when they become addicted. Instead of being able to truthfully tell their doctors about their substance problem, they have the very real fear of entanglement with the legal system and being labeled a criminal”?

    Unless I am totally wrong, for which I must apologize, I think that Mark is looking for some answers to these difficult questions. Can we define a common Moral Compass to guide us towards humane solutions?

  4. Myron Shank, M.D., Ph.D. at 10:07 pm

    @ John Quintner:

    I trust that you do understand that specifying “those who call themselves Christians” and “anyone who accepts the authority of the New Testament” are both acknowledgements of the self-evident fact that there are also non Christians and those who do not accept the authority of the New Testament. I explicitly directed my comments to a very specific point made by Mark Maginn about the New Testament view of pain. Since his point is only relevant to those who consider themselves Christians and who accept the authority of the New Testament, it is obvious that my comments about his point equally apply only to the same.

    Your speculations about “myth and religion” are neither helpful nor relevant to the understanding of my comments–comments that actually support and strengthen Mr. Maginn’s otherwise superb arguments. Regrettably, it has become clear that, rather than broadening that discussion, you have lost sight of it entirely. I have no objection to you sharing such views, so long as you do so separately, without reinterpreting my comments to suit your agenda.

    Instead of engaging you in your off-topic discussion, I will simply refer readers back to what I have written and end this exchange.

    Goodbye.

  5. John Quintner, Physician in Pain Medicine at 5:14 pm

    @ Myron.

    “My point is that anyone who accepts the authority of the New Testament, in whatever sense that might be, must also accept that it presents relief of intolerable pain as worthy of Jesus himself and, by implication, as an obligation that he imposed upon his followers, whenever they have the power to relieve it (by whatever means).”

    I do not disagree with you.

    However, as there are those who do not accept the authority of the New Testament, it was my sole intention to broaden the discussion.

    Here is another contribution.

    In his book “Richard Selzer and the Rhetoric of Surgery (1989),” Richard Anderson writes:

    In its earliest forms, medicine was an adjunct to myth and religion. Its “cures” were based largely upon rituals, medications, and surgical procedures designed to appease various deities and to drive evil spirits, demons, devices and so forth from the bodies of sick persons … To change a ritual or to alter a procedure in any way was to endanger the patient and to risk further offending the forces involved in the disease, an offense that had immediate implications for the community as a whole.

    Although the rituals and procedures for “healing” might have changed, they can still be identified today. I am of course referring to the “drug treatment system” that is the subject of Mark’s concern.

  6. Myron Shank, M.D., Ph.D. at 8:37 pm

    @ Mark Maginn:

    Even though I took issue with one point in your article, I stand by my original comment that it was “well said.” (Even my objection strengthens your overall premise!)

    In particular, I wish that every physician, politician, police officer, and commentator could be required to recite these lines every day:

    “Forty five years ago there was a terrible outbreak of heroin abuse that coincided with the winding down of the Vietnam War. That outbreak had nothing to do with opioid medicines.

    “And herein lays the problem: The choice of drugs to abuse is caused by many factors; societal, psychological, warfare, economic decline, income inequality, supply and demand for drugs, and the presence of highly organized cartels with sophisticated marketing and delivery systems.

    “The problem for people with pain [and their physicians] is that we have been singled out as the gateway through which opioids pass. Once opioids leave the medical sphere they become illegal drugs, making those who take them criminals.”

    Please keep up your good work.

  7. Myron Shank, M.D., Ph.D. at 8:24 pm

    @ John Quintner:

    I apologize for not being certain whether your response to me is a criticism of my arguments, an attempted elaboration upon them, or a misunderstanding of them, or some combination.

    My point was that the idea that there is religious merit in suffering does not come from the New Testament. As evidence of that fact, I showed that the central figure of the New Testament, Jesus, had a extremely active ministry of relieving pain (obvious in the Greek, but difficult to convey in English translation), that this ministry was given a high priority, and that he passed this role on to his “disciples” (students). It was not my purpose to speculate on the mechanisms by which this “salvation” (rescuing) from physical pain took place or what tools could or could not be used for it. My point is that anyone who accepts the authority of the New Testament, in whatever sense that might be, must also accept that it presents relief of intolerable pain as worthy of Jesus himself and, by implication, as an obligation that he imposed upon his followers, whenever they have the power to relieve it (by whatever means).

    While the fact that an intolerable pain may be amenable to medical relief ethically obligates those with that medical “power” to offer that relief, it does not preclude non medical relief. By the same token, medical relief does not satisfy non medical needs, including those that are spiritual.

    You and I have quite different perspectives on a number of things, but I suspect that you would agree with me on these statements.

    If I have missed your point, I trust that you will clarify it to me.

  8. John Quintner, Physician in Pain Medicine at 5:02 pm

    Myron, I was interested in this paragraph of your response to Mark: “I may have missed a passage, but these should be sufficient to show that the key to the entire New Testament, Jesus, himself, regarded pain as something to be cured, not endured. That he fully intended this to be ongoing is evident from his having given to his students the power to cure pain, too.”

    Here is my potted history of subsequent developments.

    The healing faculty of Jesus passed to the Church, which remained as His earthly body here below. By prayer and by calling on the name of Jesus, in virtue of the power which could work the miracle of transubstantion (of the substances of the bread and the wine), the Church staked its claim to cure disease and therefore relieve pain. In this way did the apostles and the other early Christians heal the sick, as did, after them, the saints and martyrs.

    But towards the year 900 CE (AD) the power of cure by the laying on of hands was extended to royalty. The king received this privilege when crowned by the Pope, who was God’s vice-regent on earth.

    Faith, when used by our forefathers as a remedy for pain, was robbed of its apparent efficacy by the Enlightenment. The sciences of chemistry and medicine with their ancillary disciplines issuing from this new spirit gave hope of fulfilling the promise that suffering humanity could be helped more by science and art than by faith, herbal remedies or alchemy.

    However, pain continued without cessation until relief was eventually provided by an exact science – that of gaseous anaesthesia. This was a significant landmark in the history of Medicine. Over the centuries, the practice of Medicine had previously enjoyed an uneasy relationship with the Church.

    Eventually the Church’s role in healing was largely eclipsed by that of Medicine, and the ceaseless search for remedies for those suffering persistent pain has continued up until the present day.

    For many of these people, faith and hope remain of central importance in their struggle to find meaning in their lives. Medicine alone cannot perform this role! One may justifiably conclude that, at least in our Western societies, there is a large void to fill.

    Reference: Fulop-Miller R. Triumph over Pain. Translated by Eden and Cedar Paul. London: Hamish Hamilton, 1938.

  9. Mark Maginn at 12:40 pm

    Myron

    Thanks for your long, considered and educational response to me. Of course you are “right on the money. When I wrote that comment I was truly thinking of my own encounter with this a child raised in the Catholic Church up through my 2nd year in high school. In my experience of the religion through the nuns and brothers pain was to be welcomed and that human suffering was to be welcomed as completing the suffering of Jesus. I read about this years later & could no more understand it then than when I was 13. In essence I was commenting on my personal experience of pain and suffering on an entirely personal level & not based on any scripture. Hope that helps explain where I was coming from with that comment. Again, thanks for taking the time.

  10. Myron Shank, M.D., Ph.D. at 5:14 pm

    @ Mark Maginn:

    You blamed a “religio-cultural attitude” for a “pain stigma goes all the way back to New Testametn [sic] stigmata and, as we know from that bit of religious belief, pain is not only to be endured, but welcomed.”

    I cannot speak for any “religio-cultural attitude” about pain, but I can read the New Testament. My translations of relevant passages follow (I have emphasized conveying the sense and imagery of the Greek text over creating beautiful English.).

    Matthew 4:24–And they brought to him [Jesus] each of the sick having various chronic illnesses and being held by pains and being demonized and being moonstruck [=insane] and paralyzed persons, and he cured them.

    Matthew 8:5-7,13–And his [Jesus’] having entered into Capernaum a centurion came to him calling upon him and saying, “Master, my boy has been thrown paralyzed in the house, being terribly examined [=tortured].” And he [Jesus] said to him, “I having come will cure him.” . . . And his boy was cured in that hour.

    Matthew 10:1–And having called to himself his twelve students he [Jesus] gave to them authority over impure spirits so as to throw them out and to treat all chronic disease and all flogging [=tortuous pain].

    Mark 3:10–For many he [Jesus] cured, therefore all who were having floggings [=tortuous pains] [tried] to fall upon him in order that they might impact-touch him [=capture his attention?].

    Mark 5:25-29,34–And a woman being twelve years in a flowing of blood, and much having felt heavy emotion [=suffered] under numerous curers and having spent everything of hers, and in no way having benefited, but rather having come into the worse [condition], having heard about Jesus, having come behind in the crowd fell upon his cloak. For she said, “If I might fall upon so little as his cloak I will be rescued.” And immediately the flow of her blood was dried and she knew in her body that the was cured from the floggings [=tortuous pains]. . . . And he said, “Daughter, your faith has rescued you. Go under [=with a changed relationship–in other words, no longer ceremonially unclean] in wholeness and be whole from your floggings [=tortuous pains].”

    Luke 7:21–In that same hour, he [Jesus] cured many from chronic illnesses and floggings [=tortuous pains] and painful spirits, and he exercised grace to many blind people to see.

    I may have missed a passage, but these should be sufficient to show that the key to the entire New Testament, Jesus, himself, regarded pain as something to be cured, not endured. That he fully intended this to be ongoing is evident from his having given to his students the power to cure pain, too.

    Note that a distinction was made between chronic disease and intolerable pain (a concept that many modern physicians have yet to grasp) and that curing pain was given an equal standing with curing chronic disease, paralysis, and insanity.

    Whatever one’s beliefs about the nature of demons and impure spirits in the New Testament, the evidence is unambiguous that they were considered enemies to be vanquished whenever and wherever they were encountered, and the curing of pain was listed on equal basis with doing so.

    Even though it may be accepted by many who consider themselves Christians, the notion that we earn favor of the gods or God through penance is an ancient pagan concept that has been carried down to the present. People may believe it anyway, but they should not to misattribute it to the New Testament. Whatever one’s view of the New Testament, it clearly presents pain as something from which we are to be rescued (=”saved”–and yes, it is the same Greek word).

    As physicians, we have an ethical obligation to relieve intolerable pain whenever we can, and not to do so makes us as guilty of torture as if we had inflicted the pain, ourselves.

  11. Mark Maginn at 5:35 pm

    John, thank you so much of the link to your web site. Unfortunately, my computer skills are some where trapped in the 1950s. Could you help me access the paper you’ve referred to on pain stigma & any other Australian sources you can put me on to. I think pain stigma goes all the way back to New Testametn stigmata and, as we know from that bit of religious belief, pain is not only to be endured, but welcomed. This is a religio-cultural attitude so deeply ingrained in the west that it is something that needs to be taken on seriously and with respect. Pain has been with us since life has formed and become more complicate by religious, political and, even more deeply, cultural norms as passed among generations by cultural specific norms. It isn’t just science we are working with-and against-but deeply held cultural stories and myths as they are played out in the media, especially films. Just think of John Wayne movies & war stories where the heroes magically ignore the painful injuries that would at the very least incapacitate the normal person. In short, we, in addition to the science, need to address and defusse the mythology of pain in or respective societies. Thanks for your help in this.

  12. John Quintner, Rheumatologist at 2:26 am

    Mark, we have recently published a paper looking at the stigmatization of chronic pain sufferers and what we refer to as the negation of empathy. You can access it as a free download from the website of Painaustralia, the peak pain body in our country. Combating stigma is given a high priority in our National Pain Strategy. Achieving this is easier said than done!

  13. Mark Maginn at 9:01 pm

    Dr. Quintner,

    Thank you for your considered comments. I agree with you wholeheartedly that the underlying problem in many medical, social, and political disputes revolve around the lack of or withdrawal of empathy. In medical training I can easily see your train of thought. But it occurs to me that much of the disputes that arise in medical and other areas of debate, or contention, is the withdrawal or muting of empathy of one or both sides of an issue. It has been my experience that the failure of empathy usually makes itself known in that party that is, what we might say as, on the offensive. To be more clear, in political debates I have found the absence of empathy most prominent with the more conservative elements of the commentary. I’m not saying that across the board conservative opinion lacks empathy, but it does seem that the withdrawal of an empathic response to the other side seems more likely to occur with the farther right of the commentary. For example, it is easier to demonize pain patients who rely on opioids that those patients that don’t. Or in the political sphere it seems easier to demonize those in need of the safety net than those lucky enough to maintain their employment. There is nothing scientific in this, it is just the observation of discourse that arises in these areas of contention. Again, thanks for sharing your observation with us.

  14. John Quintner, Physician in Pain Medicine at 12:33 am

    Myron, I must say that I find it hard to comprehend why “physicians who faithfully follow the law, the regulations, the guidelines, the recommendations, the standards of care, and medical ethics to comprehensively diagnose and treat patients with chronic pain” have become criminal suspects. In my opinion, such physicians are deserving of hearty approbation rather than condemnation.

    Erika, when one looks carefully into the issue of stigmatization of chronic pain sufferers in our respective societies, it appears to me that at least some of it can be traced back to the often unintentional denial of empathy by health professionals (my medical colleagues included). If this is so, it only emphasizes the failure of education and training of those in the very professions that, as you rightly say, “should step up and help” people in pain.

  15. Erika at 8:32 am

    When I 1st started speaking out against the phoney and hypocritical “War on (Some) Drugs (But Not Others)” in the 1980s, people looked at me like I had 2 heads. I am glad that people have educated themselves and these ideas have filtered into the mainstream. Criminalizing addicts for merely possessing and using drugs will not help and confusing patients with legitimate pain control needs with addicts will definitely not help! There is so much ignorance and much of it is in the medical system, the very system that should step up and help. Pain treatment education and addiction education, with the realization that these are 2 totally separate things, needs to be mandatory for all health care workers.

  16. Myron Shank, M.D., Ph.D. at 7:47 am

    Well said.

    Do not forget that it is not only those patients who faithfully follow their physician’s instructions who are viewed with suspicion as criminals, but also the physicians who faithfully follow the law, the regulations, the guidelines, the recommendations, the standards of care, and medical ethics to comprehensively diagnose and treat patients with chronic pain.

  17. Christina at 5:31 pm

    Mark RIGHT ON!!!! How come there are so many solutions but nothing is changing. Cutting patients off cold turkey has so many bad effects. How about all the families that are ruined over making patients suffer. This horrible effect no political party wants to except or talk about!

  18. John Quintner, Rheumatologist at 4:11 pm

    Mark, I wholeheartedly agree. Yes, the wars must end but there are still some big battles to be fought and won in your country. Number one objective for people in pain and those who support them is to overcome a widespread IGNORANCE. In this regard, your comments are “spot on”.