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Progress in Pain Relief by Thomas S. Szasz

The following essay is reproduced here by permission of Sheldon Richman, Editor, Ideas on Liberty.
Ideas on Liberty is published by The Foundation for Economic Education, Irvington-on-Hudson, NY 10533.
Szasz, T. Progress in Pain Relief. Ideas on Liberty, 50: 33-34 (September), 2000.

PROGRESS IN PAIN RELIEF

Thomas S. Szasz, M.D.

"Among the remedies which it has pleased the Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium."
--Thomas Sydenham, M. D. (1680)

The authors of the textbook of pharmacology used when I was a medical student (during World War II) stated: "The opium alkaloids have no rival for the relief of pain..." (emphasis in the original); to support this opinion, they added: "Sydenham ... remarked that without opium few physicians would be sufficiently callous to practice therapeutics."

The Oxford English Dictionary dates the origin of the term "Laudanum," an alcoholic tincture of opium, to 1600. For the next three hundred years, this effective and safe pain killer was available for pennies to anyone who needed or wanted it. Throughout those centuries -- indeed until past World War II -- the concept of untreated or undertreated pain was absent from medical discourse.

As recently as the 1960s, cough syrup containing codeine was available over the counter and opiates were widely prescribed for pain. The terms "prescription drug abuse" and "improper prescribing habits" had not yet entered our vocabulary. Today, the unavailability of opioid analgesics (pain killers containing alkaloids of opium) in pharmacies is a problem studied by medical scientists.

In the glory days of the Soviet Union, butcher shops were devoid of meat. To devout communists this was evidence of the moral superiority of socialist "social justice" over the decadent consumerism of capitalist exploitation. In the glory days of America's war on drugs, pharmacies -- especially in black neighborhoods -- are devoid of opioid pain killers. To devout drug warriors and to their pusillanimous critics this is evidence of medical progress in pain relief, with "racial bias" as its unintended side effect.

"We don't carry that"

That is the title of an article published in the April 6, 2000 issue of the prestigious New England Journal of Medicine. The subtitle tells the story: "Failure of pharmacies in predominantly nonwhite neighborhoods to stock opioid analgesics." The pharmacists told the authors that they do not stock opioid drugs because of "fear of theft" and "fear of penalties imposed by state and federal agencies." Anyone who lives in the United States and reads the papers or sees television could have told them this without conducting a pretentious "study," paid for by the Open Society Institute's Project on Death in America funded by financier George Soros and the National Institute on Aging funded by the taxpayer.

As if the study itself were not enough of an insult to any informed adult's intelligence, the authors' recommendation borders on being obscene. "The problem of inadequate supplies of opioids calls for a program to educate pharmacists about the safe and appropriate use of opioid analgesics... " (emphasis added). For centuries, uneducated peasants knew how to use opioid analgesics safely and appropriately. When did pharmacists unlearn this ancient knowledge?

It gets worse. The authors recommendations include "... an evaluation of regulations that may act as disincentives for pharmacists to stock controlled substances." Don't we know -- without further studies -- that if opioids were deregulated and sold in the open market, thieves would have no more reason to steal opium from pharmacies than they have to steal onions from supermarkets; and that there would be a plentiful supply of pain killers in pharmacies, just as there is a plentiful supply of food in our markets?

"Unacceptable facts"

Our collectivistic-totalitarian drug control policies not only deprive suffering patients of the kinds of pain relief to which people had free access in the days of prescientific medicine, they also debauch the language, robbing people of the tool necessary for recognizing that they are responsible for the problem, created by their own longing for statist protection from "drug abuse."

Underscoring the importance the editors of the Journal attach to the study, an editorial -- titled "Racial injustice in health care" -- calls the disproportionate deprivation of black patients of opioid pain killers an "unacceptable fact." However, the phenomenon they deplore is not simply a "fact." Rather, it is the consequence of a deliberate policy (another consequence of it being the disproportionate number of black youths deprived of liberty because of drug law violations, a "fact" the authors of neither the study nor of the editorial consider worth mentioning).

What, moreover, are we to make of physicians associated with prestigious institutions calling facts "unacceptable"? Don't they know that the adjective "unacceptable" pertains to behaviors or policies, not to facts (which simply are)? Or do they know it and choose this language to lower the volume of their criticism of drug policies to the point where no one will hear it and hence no one will take offense? This supposition is supported by their spouting politically correct platitudes such as: "We believe the common thread in these findings is a subtle form of racial bias on the part of medical care providers. The level and extent of this problem are unknown, but it is real and potentially harmful, even though predominantly unintentional." The "unintentional bias" -- an oxymoron -- is no doubt the symptom of a mental illness, due to an as yet undiscovered brain disease, for which no one is responsible.

The mind boggles. We spend more money on medical care than any other people in the world. And what is the result? That we live in a society in which suffering patients who, according to doctors, have urgent need for legal narcotics have no access to them, while people who should not have access to illegal narcotics have unlimited access to them. Who is at fault? No one. Everyone is a victim: patients, of lack of effective pain killers; physicians, of draconian drug laws making them afraid to prescribe narcotics;and pharmacists, of high crime rates making them avoid stocking opioids in black neighborhoods.

Sydenham, as I noted at the beginning, attributed the miraculous powers of opium to relieve pain and suffering to the Almighty God. What God has given, the Therapeutic State has taken away.