The Elephant in the Newsroom: Drug Policy and Michele Bachmann’s Migraines

Ed. Note–This post originally appeared on August 1. We removed it briefly while pursuing an opportunity to speak with Rep. Bachmann about the questions posed below. Unfortunately, the Bachmann camp did not respond to our query. We welcome readers’ insights into the candidate’s stances on these issues and urge fellow bloggers and mainstream journalists to ask Bachmann about her approach to drug policy – and pain management praxis in particular – if given the chance.

Tucker Carlson: Trouble-Maker

Points has been investigating the regulation and increasing criminalization of opioid pain medications in the U.S. with posts like Siobhan Reynolds‘  on DEA meddling in pain management practices, Joe Spillane‘s on historical accounts of law enforcement interference in medicine, and Kenneth Tunnell‘s look at the first OxyContin scare. Conservative political news site the Daily Caller (run by formerly bow-tied pundit Tucker Carlson) alleged in late July that Republican presidential candidate Michele Bachmann takes “all sorts of pills” to deal with “incapacitating” migraines. Since narcotic pain relievers are one of several tools in many a migraineur’s survival kit (as well as that of at least one president), that story got us thinking about how the congresswoman’s experience with chronic pain might affect her approach to drug policy. The response to the allegations also illuminates the way in which media discourses work to reproduce normative representations of gender and power, even when media commentators attempt to upend those discourses.

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Points on Blogs, Coming Soon

Editors’ Note: Next week we begin a new series introducing our readers to other interesting and/or useful blogs.  From the beginnings of the Points blog, we have been conscious–and appreciative–of the work of our fellow bloggers, but have spent precious little time acknowledging that work.  Dedicated readers of Points will remember this early exchange with …

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Bound by Law? Questioning the “Lobster Trap” of the Controlled Substances Act

In her fourth in a six-post series for Points, Siobhan Reynolds reviews the policies and judicial precedents that leave doctors unwilling to prescribe opioids to patients in pain. Reynolds focuses in particular on how federal control of the medical profession undermines the political structure of the United States and the opportunities for freedom and experimentation federalism provides.

In an earlier blog post I suggested that I would explain the reasons why physicians are loath to treat pain with opioids despite their noted efficacy; I’ve mentioned that medical professionals don’t like to admit that they are afraid to prescribe these medicines, preferring instead dole  out far more dangerous non-controlled drugs on the grounds that opioids are “bad” in some special way having nothing to do with their actual utility or safety profile. In this post, I will examine how the profession developed such a seemingly irrational blind spot where opioids are concerned. This blind spot has its roots in the interpretation and enforcement of the Harrison Narcotics Tax Act of 1914 and the more recent Controlled Substances Act (initially passed in 1970).

Years ago, when I sat at my computer in my kitchen in New York City, wondering how in the world it was that doctors simply refused to effectively manage their patients’ pain, I researched the law myself.

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Abusive Treatment: Drug Prohibition and the Erosion of the Doctor/Patient Relationship

In her third guest post for Points, pain relief activist Siobhan Reynolds traces the unraveling of the doctor-(pain)patient relationship under drug prohibition.

Siobhan Reynolds Looks for the Missing Connections Between Doctor and Patient

Perhaps the most disturbing consequence of opium prohibition, and the one least talked about in polite company, is the steady degradation of the doctor/patient relationship that has occurred since prohibition’s inception. In poor countries, where opioids are not at all available, physicians speak truthfully to their patients when they tell them that they have nothing with which to relieve their pain. In countries like the United States, where opioid pain medications are ostensibly legal but where physicians have been intimidated into withholding pain treatment, the doctors feign their impotence. There is certainly a great deal of pain relief to be found in opioid medications, and they are stacked on the pharmacist’s shelves. But physicians in the US are jailed – often arrested by SWAT teams, de-licensed and destroyed financially – for treating pain in a manner inconsistent with the opinions of government lawyers and agents. If you ask the physician who refuses to treat pain with opioids if his fear of official attention is the cause of his failure to serve his patient, you will likely meet with something quite different than such a humble confession. Instead, you will hear about how addictive the opioids are, or the doctor will say that their use should be confined to the care of the terminally ill, when addiction is not a concern. And he will extol the virtues of the anti-inflammatory and of psychiatric drugs. He will talk about the miracle of biofeedback and the importance of a positive outlook on life in the treatment of pain.

All of these responses have their place in the treatment of pain after the pain has been medically controlled. But recommending these adjustments as if they replace the pain relief provided by opioids is like telling a woman whose house is burning that a simple glass of water will fix her problem or a diabetic that he must exercise to earn his insulin. To a person in suicidal levels of pain, this kind of dissembling amounts to psychological and physical abuse. And yet this conversation between doctor and patient is par for the course under drug prohibition. It is a refrain patients hear over and over, until they finally stop searching for relief and eventually give up on living all together.

The fundamental truth that confronts anyone concerned with the quality of the doctor/patient relationship under drug prohibition – namely, that doctors have in essence been turned against the interests of their patients – remains almost entirely unacknowledged by the profession as a whole.

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Want Pork? Get Clean Urine!

In an unusual display of equanimity, the Florida House of Representatives yesterday briefly considered requiring ALL recipients of government pork to undergo drug testing to demonstrate their eligibility.  This was a happy moment in this legislative season’s otherwise long sad march down a pee-soaked trail.

Florida's Motto: "Clean Pee or Die"

Last month, Senator Steve Oelrich (R-Alachua) introduced a bill that would require all applicants for Temporary Assistance for Needy Families to be screened for drugs–at their own expense.  While such a requirement might seem, oh, onerous and unconstitutional, Oelrich kindly explained that in fact it is “an offer of help and a wake-up call” to the poor benighted wastrels who would scrounge at the public trough.  Furthermore, mandatory testing of welfare applicants should not be seen as in any way stigmatizing or moralizing, because the previous month our Governor, Rick Scott, has also begun to demand testing of all state employees.  (No dirty drops yet for the managing editors of Points.) 

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Summer School!

The good souls over at DoseNation offer a link today to a series of classes taught in 2006 by UC Berkeley Behavioral Pharmacologist Dave Presti. “The major focus of the course is on the relationship between behavior and the physiological actions of drugs. Emphasis will be placed on effects of pharmacological agents on complex mental …

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Teaching Drugs and Alcohol through the Filter of Student Life

In his second week as a Points Guest Blogger, Eoin Cannon reflects on the difficulties of talking intelligently about addiction with a roomful of undergraduates who may still be hungover from the night before.

Last fall, I taught a course called “Stories of Addiction” for my university’s Freshman Seminar program. It was the first opportunity I’d found to teach my scholarly interest in a sustained way. As in approaching any new course, I gave some thought during my preparation to what beliefs, assumptions, and values students would bring to the topic. In departmental courses, I think, you can count on your discipline’s critical tools, and your students’ developing comfort with them, to create analytical distance. Not a space, hopefully, in which personal experience is unwelcome, but one colored by the implicit understanding that our main purpose here is not to do therapy or reproduce conventional wisdom.

But three factors made the issue of distance particularly salient in my seminar. First, it was for freshman only, during their fall semester. They had no experience with college-level critical thinking. Second, the seminar context, combined with my own approach to the topic, put the course outside of any single disciplinary framework and its implied critical distance.

Your Experience Here

It wasn’t “addiction in literature,” it wasn’t “the history of addiction,” it was just “addiction stories,” and the shapes they take, the work they do, in various contexts. I was using the category of narrative to develop an interdisciplinary framework that would not be obvious to students. Third, and most important, alcohol/drugs is a topic freighted with official and unofficial discourses that play key roles in the social identities of college students.

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