“We’re Not In Wonderland Anymore, Alice” (Charles Manson)

I’ve contributed to The Health Care Blog a couple of times and follow its posts to stay on top of issues relevant to health care. Dr. Al-Agba wrote this article recently in relation to the recent shooting at Bronx-Lebanon Hospital in the Bronx (see link here). I think Manson was wrong; I think we are, indeed, still in Wonderland as it pertains to mass killings.

Dr. Al-Agba makes the very good (and one might argue rather obvious) point that organizations we work for have an obligation to take threats to our personal safety seriously. Today, if an individual threatens suicide, most people know that such threats should be investigated. Lives have been saved as a result.

Still not so with homicidal threats despite the carnage (and I’ve been maintaining this to anyone who will listen since I studied school shooters in the late 1990s while a student at John Jay College of Criminal Justice; it has been discouraging to know that not many have listened). This is the most pertinent line from Dr. Al-Agba’s article: “After his resignation, Dr. Bello warned former colleagues he would return someday to kill them.” Bronx-Lebanon did what in response to this threat? It’s not clear but so far I have found no evidence to suggest they took any action (i.e., reporting it to police? Seems like that would have been a good place to start).

Dr. David Lazala, who worked with Dr. Bello, described him as “very aggressive, talking loudly, threatening people,” and said that he had been threatened by Dr. Bello via email after Dr. Bello had been terminated. I could not find out if Dr. Lazala told Bronx Lebanon about these threats. But even if he had, consider what Bronx Lebanon would have done after you read about my experiences working as a clinician in New York City since 2003. Continue reading

Lies and Omissions of the “Opioid War”

I’ll be writing a series of little posts here about various articles in the media regarding the war on opioids, as I find that the news media often doesn’t tell the full story, and seems to be following (or promoting) a morality play or political narrative, rather than actually presenting the problem as it is.

This article from The Economist I found curious mainly because writers such as this almost always maintain — without any real attempt at argument– – that prescription opioids don’t “work” for chronic pain. As a someone who suffers from chronic pain, I can assure you that nothing could be further from the truth.

Prior to having spinal fusion in 2013, I was on a long-acting prescription opioid. Because I still had some pain, I thought the medicine wasn’t working, so I went off of it, only to become essentially nonfunctional for six weeks. I was in so much pain that I lost my wallet, my keys, my Kindle, my smart phone, and even my car all within a span of six weeks.

It was then that I discovered that my spine was essentially crumbling, that I had no disk left at L5, and that L4 wasn’t looking too much better. I needed major surgery on my lumbar (lower) spine.

If we restrict access to pain medications, the result will be more people in pain, more nonfunctional, and more on disability. Back pain is the most common cause of disability in the entire world. Restrict access to pain medications in the way that so many advocates demand, and we’ll essentially be denying needed relief to millions of people in serious pain. That relief allowed me to work. Was opioid use ideal in my case? No, it wasn’t, but it kept me working, and it’s hard to discount the importance of a paycheck.

It’s already challenging enough to get these medications, even with a prescription. In fact, I’d have to see my doctor monthly to get the relevant prescriptions in New York State, where I live. The fact that these visits are both costly and medically unnecessary seems irrelevant to politicians content to sacrifice people like me to their newfound compassion for addicts.

We can do little for addicts who refuse assistance. Some of them will die. But by indiscriminately trying to control the availability of these medications both to addicts and to those who genuinely need them, we would deprive millions of people access to the medications they need to avoid having to live a life completely in thrall to physical pain. In weighing the costs and benefits of any policy concerning pain medications, it might help to imagine what it’s like to live a lifetime in serious pain–with painkillers, and without.