Should Public Health be an Instrument for Policing?

Should Public Health be Used as an Instrument for Policing? | Terri A. Lewis | Assistant Professor, Rehabilitation Counseling & International Programs Consultant at National Changhua University of Education | Nov 17, 2015

Today I was copied a response to the recently issued document, “The Prescription Opioid Epidemic: An Evidence-Based Approach” published by Johns Hopkins Bloomberg School of Public Health.  

The 46 page document is full of pronouncements about what the proper course of action should be to rein in the abuse of opioids by people who experience unrelenting chronic pain on a daily basis.  The document is replete with terms like addict, addiction, surveillance, monitoring, intervention, adherence, and conformance distributed across seven topical areas, all claiming to address the current evidence for the need to ramp up the nanny state:  

  1. Prescribing Guidelines
  2. Prescription Drug Monitoring Programs
  3. Pharmacy Benefit Managers and Pharmacies
  4. Engineering Strategies
  5. Overdose Education and Naloxone Distribution Programs
  6. Addiction Treatment
  7. Community-Based Prevention

Nowhere, does this document even remotely address the fact that the onset of chronic pain is often an iatrogenic event that occurs as the result of medical harm or insufficiently delivered medical care.

Nowhere, does this document address the financial and practical impact of these pronouncements on the ability of persons who have lost everything to illness to conform to protocols that turn healthcare  delivery into a policing activity.

Everywhere, these protocols engender the further revictimization, the institutionalization of marginalization and stigmatization of the chronically ill as unworthy, incapable of protecting themselves, and potentially harmful to themselves and others because of the characteristics of their illness imposed disabilities.

this document, from a major public health training institution, completely fails to address the prevention and reduction of chronic pain as a public health issue of significant importance, focused instead on counting adherence, conformance and compliance activities that will

(a) not lead to improved personal outcomes for consumers who live with chronic pain and
(b) rob consumers of precious resources with which to live.

These pronouncements reflect an ignorance of astounding proportion in understanding who persons with chronic pain actually are and the conditions under which they are forced to live.

a response to this smug, sanctimonious document from a woman in California who suffers from interstitial cystitis – acquired through medications she received after treatment for shoulder and spinal injuries at the hands of her medical provider.

To the misguided folk at John Hopkins Bloomberg School of Public Health:

This is my contribution to your little Town Hall hand-wringing session:

Just another organization that feels compelled to point at anyone who takes  opiates, and call us all “addicts” and not even considering those of us who suffer from severe CHRONIC PAIN (the kind That Never Ends) due to circumstances totally beyond our control.

My pain is not caused by any flaw in my character.

I guess Chronic Pain Patients’ Lives DON’T Matter.

I’m one of those people, who suffer from illnesses and or injuries that have already stolen our quality of life away from us, and pain that causes as much, and sometimes more, pain than cancer.  People who suffer from pain that only opiate prescription medication can dull.  

And people like you, whom I will never meet, want to take that away from me.  A patient who has NEVER EVER ABUSED HER MEDICATION.  Not ONCE.  

I am a 60 year old lady who worked her entire adult life and never once did anything to invite nor cause the condition that causes me terrible TERRIBLE pain.

Interstitial Cystitis is considered the Third Worst Pain in all of medicine.

My urologist opined that I would be better off if I suffered from Bladder Cancer, because there is at least a chance of recovery from that illness.

All a doctor can really do for me to help me is provide me with pain relief.

The only medication I take that takes the edge off of this pain is Norco.

So why am I going to be punished?  Answer me that question.  I just found out that my pain medication is going to be cut drastically OR terminated at my next visit to my pain doctor, which is this Friday.

It is not being taken away because I have ever abused my medication, or lied, or deceived, or stolen, or sold it.

We are a vulnerable part of the population who are being deprived of compassionate and adequate care to help us live our lives with a semblance of normalcy.

We are being punished for the irresponsible actions of people who would be addicted whether or not it was via opioids or anything else.  All of this noise is just that:  NOISE.

People who are addicts will always find a way to get high.  That is what addicts do.

Addiction is in the person, not the drug!

The pain of illnesses like mine can and does drive good people to commit suicide if they can’t get pain relief.

No one is speaking up about us. No one is helping us.

Chronic pain patients are being marginalized and treated like addicts, when we are not.  We can barely function because pain robs us of the ability to function, and we are already exhausted from this daily fight.  I guess we are easy targets.

I guarantee that if any of you people making these horribly unjust decisions suffered from the condition I suffer from, that you would be begging for drugs to take the pain away.

So, in summary, what you are doing is KILLING US.  

You, and 60 Minutes, and the CDC and the DEA and every other soulless agency that is carping about this.

Dumping every single person who takes opiates into a category you call “addiction” and shoving us off in the same leaky boat.  Yes.  You are killing us”

— Name withheld to protect her privacy

For the record, this person also found out last week that her beloved husband of 20 years is in the throes of stage 4 kidney failure as the result of 5 years of treatment from a physician for arthritis – resulting in an unidentified drug-drug interaction that has, unbeknownst to the physician, destroyed his patient’s kidneys because he failed to monitor his patient or pay attention to known drug-drug interactions.

So who needs monitoring and surveilling here?




One thought on “Should Public Health be an Instrument for Policing?

  1. Payne Hertz

    It’s an authoritarian “solution” by an authoritarian system. It’s undeniable at this point that many leading institutions in the American medical system believe people in pain who require opioids to reduce their pain should be subjected to a degree of control and “surveillance” usually reserved for hardened criminals. The report uses reduction of opioid prescriptions as a metric for “success” without ever considering that there might be a downside to denying people access to pain medications, such as increased suicide, or increased mortality from failed surgeries and drugs like NSAIDS whose lethal toxicity has been underestimated. The word “suicide” doesn’t appear in the report.

    The fact that there is an obsessive focus on the alleged dangers of opioids while all other causes of iatrogenic harm are largely if not entirely ignored speaks heavily of an agenda. Imagine if efforts to reduce the murder rate were focused exclusively on one segment of the population that was not in fact responsible for the majority of murders, such as gay people. Article after article about the “epidemic” of murder among gay people while completely ignoring the fact that gays are not responsible as a group for the majority of murders.

    Surely, the agenda here would be obvious? That the researchers are more interested in demonizing gays than in reducing murder.

    That is the situation people in pain find themselves in, where the one treatment that works for many of them has been singled out for scrutiny to the exclusion of all other causes of medical harm, even though “opioid-related” deaths are poorly defined and understood and are a mere fraction of the overall iatrogenic death rate due to medical error which has been estimated to be over 450,000 a year. This figure does not include non-error medical deaths.

    In my opinion opioid medications are a victim of their own success. They are the safest and most effective medications for the treatment of pain and tend to work immediately, rather than over the course of months or years. For people who need to be able to get to work to feed their families today not next year the “quick fix” provided by instant pain relief from opioids makes them appealing over long-term therapies of dubious value in reducing pain, such as cognitive behavioral therapy, injections or surgeries.

    That’s a lot of lost income for those who profit from these interventions so their hostility to opioids is easily understood, as is their blindness to the risks and failures of their own medical interventions.

    There has to be a hard look at the financial motivation of those who either wish to reduce access to opioids or heavily “monitor” those who use them.

    Liked by 1 person


Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.