The NFL’s Pain Management Problem

Editor’s Note: Today’s post comes from contributing editor Bob Beach. Beach is a Ph.D. candidate in history at the University of Albany, SUNY.

The National Football League (NFL) has a pain management problem. It also has a marijuana problem. The league currently regulates marijuana use among its players as part of its Policy and Program on Substances of Abuse. Revised in 2018, the program tests players for marijuana (and other “substances of abuse”) once every year during a set time (during the offseason). 

The threshold to trigger a positive test is a relatively small 35 nanograms of THC per milliliter. To get a sense of how much that is relative to common testing thresholds, one source suggests that, “following a single marijuana use, THC is unlikely to be detected in the urine beyond 3 days at the 50 ng/ml cut-off level and beyond 7 days for the 20 ng/mL cutoff level.” If a player fails a test, they face fines, suspensions, and more frequent and random testing. 

Often touted more as an “intelligence test” than a drug test, at least for marijuana (are players smart enough to stop smoking weed prior to the testing window?), the program still ensnares new players every season, including David Irving, who recently quit football live on Instagram while smoking weed, following a failed drug test which triggered an indefinite suspension by the league.

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Fiction Points: Amy Long

  Amy Long is the author of Codependence: Essays (Cleveland State University Poetry Center 2019) and a founding member of the Points editorial board. She has worked for drug policy reform and free speech advocacy groups in California, D.C., and New York; as a bookseller at Bookpeople in Austin, TX; and as an English instructor at Virginia Tech …

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Interpreting Donald Trump’s “Oxy Electorate”: On the Interaction of Pain and Politics

On January 20 – inauguration day – the HBO news talk show Real Time with Bill Maher aired its fifteenth season premier. Unsurprisingly, Donald Trump was the topic of the hour. After Maher and his panel of pundits concluded their discussion, the host delivered an editorial monologue analyzing Trump’s electoral victory and offered a provocative comparison:

“Here on inauguration day, in the spirit of new beginnings, liberals have to stop calling Trump voters rubes and simpletons and instead reach out and feel their pain, the pain they insist we didn’t see. And there is ample evidence for that pain. Did you know that of the fourteen states with the highest painkiller prescriptions per person, they all went for Trump? Trump won eighty percent of the states that have the biggest heroin problem… So let’s stop calling Trump voters idiots and fools and call them what they are: fucking drug addicts!”

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Will I Be A Dope Doctor When I Grow Up?

EDITOR’S NOTE: Points is delighted to welcome Kim Sue, a previous contributor (check out her earlier posts here and here), medical anthropologist, and dual degree MD/PhD candidate at Harvard University. On the heels of Points’ recent posts about the difficulties of reconciling clinical and scholarly perspectives on addiction treatment and the media frenzy about the recent prescription opioid epidemic, Sue offers a historical and ethical reflection on having the power to dispense prescriptions.

I first met Anita in the Boston jail where she was doing time for passing bad checks related to a prescription opioid addiction. She had first been introduced to opioids after giving birth to her first child several years earlier. “I was prescribed percs [percocets] for pain related to the delivery,” Anita explained. “I just remember taking them and being high and cleaning … I took four or five at a time.” Anita’s drug use spiraled out of control, as her physiological tolerance to the opioids increased and she needed to buy more and more pills to get the same effect. One day, Anita’s dealer offered her heroin, and off she went.

Ethnographers and historians of drug use are all too familiar with stories that resemble Anita’s. As an anthropologist who studies prisons and addiction treatment, I find it relatively easy to point the finger at doctors for their professional complicity in “epidemics” of opioid addiction.

But as a medical student in my final year, destined to start residency in July in an internal medicine-primary care program, I also worry I won’t be able to refuse prescriptions for opioids for patients presenting to me in distress and pain.

Historians of medicine and drug use have detailed how physicians—whether they wanted to or not—became central to the distribution and administration of opioids in the United States. In the wake of the Harrison Narcotics Act, addicts had to obtain prescriptions for their drugs, and so-called “dope doctors” would provide them for cash. The alternative to the dope doctor was the street druggist, the so-called “pusher.”

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Laudanum (image via Science & Society Picture Library/Getty Images)

 

Doctors and opiates have a long, complex history. In the era of magical formulations, Dr. Thomas Syndenham compounded laudanum by mixing “two ounces of opium and one ounce of saffron dissolved in a pint of Canary or sherry wine” with a “drachm of cinnamon powder and of cloves powder,” as historian Richard Davenport-Hines noted in his history of the subject. At the time, opiates (plus or minus alcohol) were among the few medicines that were actually effective pain relievers (working at the μ pain receptors in the brain). They were instrumental in bolstering the medical profession’s emerging reputation for dispensing effective interventions rather than simply bearing witness to suffering. Indeed, enterprising pharmacists and doctors alike created their own patented formulations of various narcotics marketed as cure-alls– a mix of magic, profiteering, and chemistry.

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Remembering a Drug Activist: Siobhan Reynolds: 1961-2011

I didn’t keep up with my drug-related news over the holidays. I didn’t check Facebook or read any blogs. My mother was in town, and I was playing tourist. What could possibly happen, anyway, I thought, with legislators on holiday and courts out of session? Apparently, a lot.

Siobhan Reynolds, 1961 - 2011

I got an email last week alerting me to pain relief activist Siobhan Reynolds’ unexpected death. I couldn’t believe it; I searched the Internet wildly, hoping to prove this was just a rumor. But pieces at Time Magazine, The Logan (OH) Daily NewsDrug War Rant, Reason, TalkLeft, StoptheDrugWar.org, and the American Thinker confirmed that Siobhan had, in fact, perished in a plane crash on Christmas Eve. She died with her partner, attorney Kevin P. Byers (who was piloting the small aircraft), and his mother, Eudora Byers, during an unfortunately unsuccessful attempt to land at the Vinton County Airport in Ohio.

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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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We Are the Drug War: Prohibition as Success

In her final guest post for Points, Siobhan Reynolds asserts that the oft-repeated claim that the War on Drugs has failed should be reassessed from the point of view of those who profit from its outcomes. Looked at from that perspective, Reynolds sees opiate regulation as central to the drug war’s astonishing success.

Protesters Rail against the Drug War with Puns

Drug policy reformers have rallied for an end to drug prohibition calling it a dismal failure. To my mind, however, in order to understand this thing that has taken on a life all its own and to ultimately change course, if that is possible, one has to stop looking at the drug war as a failure and instead regard it as a spectacular success. There’s no denying that drug war policies and practices have turned physicians against the interests of their patients, been wildly expensive, destroyed the criminal justice

Activists Protest Drug War Over-Incarceration

system, and facilitated the incarceration of people in the United States to a degree that would make Stalin or the Chinese envious. People who value civil liberties above all other social goods undoubtedly consider such developments evidence of failure. But these chilling outcomes do benefit some. A mature view would necessitate that we look at who profits under drug prohibition in order to truly judge what it has become.

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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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