Practically all doctors (apart from pathologists) must now take courses in pain management, but not in the addiction to which the proliferation of these courses seem to have led. The author of the editorial, who is from Stanford, believes that not until doctors accept addiction as a disease, chronic and relapsing like, say, asthma, and are duly rewarded for treating it, will the problem be solved. The trouble is that addiction is not a disease like any other, any more than is burglary or driving too fast. Medical consequences do not make a disease.
Nevertheless, the editorial draws attention to the pressures on doctors to prescribe what they know in their hearts they ought not to prescribe. It omits, however, three factors: the unprecedented commercial promotion of strong painkillers by drug companies, the doctor’s physical fear of his patients (assaults by the disgruntled are not uncommon), and a strong dislike of scenes in his office. I remember very well that when I refused to prescribe either strong painkillers or other addictive drugs such as benzodiazepines (for example, valium), some of the patients would start to shout that I was not a doctor but a murderer. This was idiotic, of course, but such scenes are wearing on the nerves. Many doctors just give in prophylactically, as it were.
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