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How Doctors Turn Their Patients into Drug Addicts

The second reason proposed in the editorial for the liberal prescription of addictive analgesics, even to those patients whom the doctor knows or suspects to be abusing them, is economic. Prescription is quick and lucrative, while encouraging the patient to forego his drugs is difficult, time-consuming, and ill-paid. The doctor cannot afford, at least if he wants to preserve his income, to spend a lot of time with any one patient, and addicts denied their drugs can easily use up hours of the doctor’s time.

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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