This is Your Brain. This is Your Brain on the War On Drugs

Back at her own blog, Megan McAardle cites an article by John Tierney in the New York Times about the now-ongoing trial of Virginia pain specialist, Doctor William E. Hurwitz. (More can be found here.) Dr. Hurwitz is now on trial for prescribing "too much" pain medication to some of his patients, some of whom either sold the medication on the street or used it recreationally themselves. Megan asks:

I don't even understand how it is possible that, in order to keep some people from ruining their lives with prescription painkillers, we are willing to condemn other people to horrendous suffering. Why have so few other people noticed that this is not merely wrong, but also thoroughly silly?

It's not just silly, Megan, it's murderous. As John Tierney notes, two of Hurwitz's former patients, unable to find doctors who would treat their pain, committed suicide.

That's right. They were in so much pain that killed themselves after Hurwitz shut down his practice. He shut down his practice due to the federal investigation.

The folks who work at the DEA who investigated Hurtwitz manage to feed and clothe themselves, to tie their own shoes and to do the normal things that adults of ordinary intelligence do in their lives. The prosecutors who prosecute him may not have been at the top of their class, but they graduated from law school. Anybody who didn't ride the short bus to school ought to be able to tell that prosecuting Hurwitz is a thoroughly idiotic thing to do.

So why, Megan asks, do we do it?

Well, the "war on drugs" gets its emotional oomph because certain substances are demonized. They aren't just bad in the ordinary sense that using them to excess will result in undesirable consequences. No, they become a symbol, a manifestation of Evil Incarnate. And in order to stop their abuse, we must have a "WAR" on drugs. The folks who become involved in that enterprise become emotionally attached to it. They're not just enforcing a law; they're purging the world of Evil.

People who buy into the notion that Drugs Are Evil lose their sense of balance and proportion. Ideas about costs and benefits just don't apply, because the War on Drugs is about Virtue, about Right and Wrong. The very real costs associated with it just don't get counted. A zealot never thinks about costs and benefits, only The Cause. The War on Drugs is itself a mind-altering substance.

This all goes back to the Secret Fear theory. Above all else, the Drug Warriors fear the notion of addiction -- the idea that an Evil Substance could totally take over a person's life, become the be-all and end-all. The drug warrior fears losing rationality and control. Deep down, the Drug Warriors are afraid it could happen to them, they could become "addicted." They could be taken over by an Evil Drug.

And so they become addicted, but not in the way they fear. Addicted to control. Addicted to rules. Addicted to a constant "get tough," "get tougher," get toughest" mentality. Never mind that tougher enforcement has never worked -- they're addicted to the War on Drugs. It's what gives their lives meaning and purpose.

The fact is that many drugs -- and opiods certainly fall into this category -- are "dual use." That is, they can be used recreationally, to get high, or medically, to alleviate pain. A policy of banning recreational drug use (except for alcohol and tobacco and caffeine) therefore inevitably entails a policy of restricting dual-use drugs. If we allowed unrestricted access to opiods while continuing to ban recreational drugs like pot and heroin and cocaine, people would just substitute the opiods.

Such restrictions require that we distinguish between true medical users -- people in pain -- and people who just want to get high. Here's the rub: we don't have a painometer to see who is lying about being in pain. We have to take people's word. Inevitably, some people will lie. And they will either sell the drugs illicitly or use them recreationally. Therefore, an inevitable consequence of the War on Drugs is some social mechanism for determining who is really in pain, and who's faking it.

In his article, John Tierney talks about Dr. Robin Hamill-Ruth, one of the prosecution's paid witnesses in the Hurwitz case. He makes her look like a fool. One of her patients was a woman who had suffered really bad migraines -- so bad they put her completely out of action. I mean, bad. Really bad -- so bad she once got taken away in handcuffs because she was suicidal. This woman had actually gone to doctor Hurwitz and gotten adequate treatment, treatment that included opoids. But she couldn't do that any more, since Hurwitz's practice had been shut down. So she went to the government's "expert," Dr. Robin Hamill-Ruth. Dr. Robin Hamill-Ruth's clinic wouldn't give the poor woman medication that would, you know, help her -- you see the philosophy of Dr. Robin Hamill-Ruth's clinic "includes avoidance of all opioids in chronic headache management." So what did Dr. Robin Hamill-Ruth give to the woman who suffered chronic and debilitating migraine headaches? She gave her an anxiety medication called BuSpar. And the side effects from BuSpar include -- headaches.

Now, when I read about something like that, I have an urge to start screaming obscenities, but once I calm down, I realize that there's a certain logic at work here. We've already established that a policy of banning recreational drug use (except for alcohol and tobacco and caffeine) inevitably entails a policy of restricting dual-use drugs. We know that some people will lie -- and a headache is the easiest thing in the world to fake, for anybody with even a dollop of thespian talent. We don't have the painometer.

Perfect isn't an option. Errors will occur. We can make the error giving recreational drug users or illicit drug sellers an opening to get opiods. Or we can make some people suffer, in some cases to the point of suicide in order to stop a few recreational drug users or dealers from getting their hands on percocet or vicoden. Now, to anybody with even a dollop of reason, compassion, humanity, or empathy, it is an obvious choice: who the fuck cares if a few prescription meds get diverted for recrational use? Give people the pain relief they need.

But to the Drug Warrior, Drugs are Evil, and if a few people have to suffer, well so be it. If they end up committing suicide, too bad. Acceptable losses in the War on Drugs.