'The Sound and the Fury': Patients in Pain Need Compassion, Not Regulations

LAS VEGAS—It is imperative that the United States finds more effective ways to deal with the growing availability and utilization of opiates and other drugs for pain that is compassionate and grounded in medicine rather than criminalizing such use, said Ethan Nadelmann, JD, PhD, founder and Executive Director of the Drug Policy Alliance, a New York City-based nonprofit organization, at PAINWeek 2014.

In presenting the Keynote Address, “The Sound and the Fury: What Ending the Drug War Looks Like,” Dr. Nadelmann outlined harm ensuing from the US government's “War on Drugs,” pointing to the highest per capita incarceration rate in the world, a 10-fold increase in drug law violations over the past 30 years, and the $50-$100 billion spent annually to treat drugs as a criminal problem.

Most remarkable, he said, is the growing movement to end marijuana prohibition, with recent surveys showing more than half of Americans are now in favor of legalizing marijuana. Colorado and Washington, the first states to legalize marijuana use, may soon be joined by Oregon, Alaska, and the District of Columbia, and Florida is the 24th state considering legalizing marijuana for medical purposes. This makes sense, he said, when one realizes that half of all US drug arrests are for marijuana use, costing taxpayers untold billions of dollar as “offenders” are arrested, prosecuted, and even jailed.

He pointed to a recent article in JAMA Internal Medicine that found states with medical cannabis laws had a 25% lower mean annual opioid overdose mortality rate when compared with states where medical marijuana is illegal. While no causal relationship has been established, this is certainly a piece of evidence worth considering, he said, and underscores that different types of medications work for different people and different medical conditions, perhaps in a synergistic way.

He exhorted attendees to become powerful advocates for people in pain who need opiates—and protection against overdoses. Specifically, he asked all who write prescriptions for opioids to ensure patients have access to naloxone, which he believes should be available over-the-counter, and that they promote “Good Samaritan 911” immunity laws in their states to protect those who report witnessed overdoses and fear being arrested or prosecuted themselves for drug possession.

All of this requires a deeper understanding of the nature of pain in society and a greater—and more creative—investment in educating consumers about pain and how to manage it.

According to the Drug Policy Alliance's website, the organization “envisions a just society in which the use and regulation of drugs are grounded in science, compassion, health and human rights, in which people are no longer punished for what they put into their own bodies but only for crimes committed against others, and in which the fears, prejudices and punitive prohibitions of today are no more.” In addition, the group's “mission is to advance those policies and attitudes that best reduce the harms of both drug use and drug prohibition, and to promote the sovereignty of individuals over their minds and bodies.”

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