I've felt that the "War on Drugs" is a stupid hypocrisy for years. There is no doubt that it is the war on drugs, not the drugs themselves that causes the crime, the ODs, and just about every other negative aspect of the alleged "drug problem".

That's not what I'm outraged about today. At least, not any more than usual.

I have a bad back. I have 5 ruptured disks in my back, one of which was removed in a surgery about 12 years ago. Here's how that happened:

I was having pain in my right leg. I couldn't explain it. It became more chronic, and more severe. I tried to determine if it was related to some repetitive stress or some activity I was doing. It didn't appear to be.

I went to my doctor, who suspected this might be cyatic pain. He suggested I get a CT scan of my lower back to confirm his diagnosis. This made sense to me, so I chose to get the CT scan. It showed the damage he suspected. He then put me in touch with specialists to help me understand my treatment options. Surgery was recommended to me, but I was trying to finish engineering school.

I decided to delay the surgery, hoping I could get through engineering school and do it after graduation. The pain got more and more severe, and eventually immobilized me. I chose to have the surgery mid-term, and basically dropped out of college. This was a big decision for me, as you can imagine. I think you would have to agree that it was MY decision to do this. I decided the consequences of leaving school would have to be dealt with.

The surgery worked; the leg pain was gone. Unfortunately, I have lower back pain that I live with all the time. My back is very sensitive, and certain activities cause really bad back aches for me.

I was really impressed with how my doctor diagnosed what I thought was a leg problem as a back injury. I went back to him and told him about the lower back pain I now had. This was shortly after my surgery. He told me that it would probably always be with me, but that a mild muscle relaxant (cyclobenzaprine HCL, also known as flexorol) might help when it got really bad. He wrote me a prescription and I tried it.

The meds work, but they make me groggy, so I only take them when I'm hurting really bad and only at night. I've done this for over 10 years and it helps. I made the decision to try the meds, and I made the decision to use them only at night and only when I'm in severe pain. I think you'd agree that it was MY responsibility to make those decisions for myself, just like it was MY decision to have the surgery in the first place.

Over the years, I'd call my doctor and he'd renew the prescription for me. It is a "PRN", refill as needed, but prescriptions expire after 1 year. It expired again 2 weeks ago.

I called my doctor. They wouldn't let me talk to him, but I left a message asking for the renewal. He declined it. I called again and asked to speak with his nurse, which they wouldn't let me do. I left the nurse a message explaining the following:

- I've used this treatment successfully for 10 years.
- NOTHING has changed in my situation. My back is no worse -- I'm just out of my "back pills".
- I don't have health insurance and don't want to pay for a doctor's visit.

He refused again, saying that since he hasn't seen me in 3 years, he won't renew the script.

This is absolutely ridiculous. When I first say my doctor, I consulted him with something I didn't understand and he gave me advice. I chose how to proceed based on my respect for his advice.

This is different. I've been using this "treatment" for 10 years. I live with my back every day of my life. NOBODY is in a better position to know if the situation with my back has changed. I am keenly aware of the slightest change; I even know how weather affects my back.

It is clear to me that my doctor is requiring me to see him for reasons totally unrelated to my welfare. I can only guess what those reasons may be, but it is extremely obvious that my welfare is not the reason.

When a doctor does this, he changes the relationship from one where he advises a responsible moral agent who owns their body and assumes all risks of treatment to a relationship where the patient is a subject under the doctor's control. Worse than denying my status as a responsible moral agent, this allows the doctor to place interests above my welfare -- against which I have no recourse. Whether it is business reasons that cause him to compel me to pay for an office visit, his own fear of legal reprisals, or some other reason, the fact remains: he has violated the basic and fundamental principle of his profession -- that his patient's welfare comes first.

This is a profoundly immoral situation. Really think about this. It is a big deal. My doctor is not to be trusted to place my interests first. Neither is yours, because the system in which the doctor operates is inherently immoral.

This is the real horror of the absurd war on drugs. It turns citizens into subjects. Subjects of a priesthood of doctors who have a fundamental conflict of interest with their subject/patients.

It is as illegal for me to try to obtain this mild muscle relaxant as it would be for me to try to get dilaudid, vicodin, or reefer.

As our politicians claim to be protecting our freedoms, we willingly allow them to control what we eat and whether we choose to continue living. Are there really any more basic freedoms than those? They must be using some definition of "freedom" that I'm not familiar with.

People actually think that someone else is a better judge of how I need to care for myself and my back than I am myself! If you are someone who thinks this, consider this: who has to live with my back?

As Tony Soprano might say, "I'm being shaken down." Anyone who thinks this is OK needs to do some thinking. If you agree that I am being screwed, you may then need to rethink your position on whether I should be able to roll a fat one to get a break from my back pain. And why shouldn't I? It's my body. I assume all of the consequences. I have to live with myself. Period. Hold me accountable if I harm someone for harming them. I have the inalienable right to harm myself, if I choose to do so.

Morally, perhaps. But not legally. Not in the "land of the free".

Jim

Well, while I'm with you in general, I have to point out that maybe your doctor has a reason for wanting to see you. Maybe he has a new treatment he'd like you to try. Even if it's just a different medication, I'm sure that his malpractice insurance makes him schedule an office visit, if it's not a basic tenet of medical ethics. For that matter, maybe his insurer is now making him see patients before renewing prescriptions. Your point about the "War on Drugs" is no less valid because of those things, though. And while I can understand the idea behind restricting potential recreational drugs, why do things like extra-extra-strength ibuprofen prescription-only? I can understand them being restricted so that pharmacists can make people know the dangers behind misusing them (though taking four of those is not any different than taking a handful of ones you don't need any license for), but why make them inaccessible?

Which brings me to my other point, which is that it would certainly be (stupidly) illegal for you to obtain the Flexoril without a prescription, it is most certainly less illegal than the others you list, as it is an unscheduled drug, while Vicodin is Schedule III, Dilaudid is Schedule II. and marijuana is Schedule I.

Edit: Actually, if I understand the law correctly, as an unscheduled drug, it would not be illegal for you to possess your Flexoril without a prescription, only that it would be illegal for someone to dispense it. Which, I suppose, is how the Internet prescription drug trade works. Sounds a whole lot like our 18th Amendment now that I think about it.

Bitt, excellent points. A couple of thoughts:

As I was thinking about it, illegal is an all-or-nothing thing. Sort of like pregnancy. You make a good point that the punishment is harsher depending on the chemical properties of what I obtain and intend to eat.

If the doctor has an alternative treatment, why didn't he just say so? For that matter, why can't that be handled over the phone?

I think you're right about the doctor's motivations. This is probably due to legal or insurer requirements. But that is precisely my point. All reason dictates that this is a matter between me and my doctor, or, more accurately, it is my own issue and I choose to obtain a doctor's advice. NOTHING should be above the patient's interest in the doctor/patient relationship. In reality many things are, which is proof that the system is broken without getting into personal opinions about so-called "recreational drugs", like tobacco or alcohol.

Jim

Well, ostensibly, the reason that those rules exist is, ultimately, to protect patients. There are, I'm sure, frivolous lawsuits against doctors, but the ones that his insurer is probably more worried about are the ones that are perfectly legitimate. And if the doctor performed an exam, those problems are less likely to occur. And there is no reason, I don't suppose, that it couldn't be handled over the phone (I think this is the way some doctors work in deepest Alaska) but he'd charge you the same amount. It's still the same use of his time.

Someone was telling me that in some US state that the only legal place to buy beer is from a bar, and that the bars are only allowed to sell a case at a time, which means that if you're having a party, you have to go to the bar with your friend, have him wait outside to guard the beer as you wander in and out, buying one case at a time.

How does that work in regards to your 16-only ibuprofen rule?

You can get beer from supermarkets and licensed shops. As much as you like!

My own rant on the subject.

I hate that people with legitimate needs for mediciation (like my wife) get treated like criminals because they can't live without the drugs. Every so often my wife goes through a phase where she starts to worry that her pain isn't real and she's just addicted. At that point she'll try reducing her medication drastically and the end up spending the week in bed because of the amount of pain she's heaped on her body.

Living with back pain for the rest of your life is hard enough without adding insult to injury.

Speaking of back pain: Anyone in your situation needs to read this book. Chronic back pain is nearly always curable, without surgery -- and surgery nearly always only makes things worse. The problem is, not many doctors seem to know or accept that, and even fewer modern doctors seem to have the slightest clue about curing back pain. Oh, and another (cheaper) book as well.

Cheers

It's different state-by-state. That may be the case where you live. It is where I live. But not everywhere.

I think I am right in saying that there are no OTC sleeping tablets in the UK (excepting those herbal ones that seemed to have zero effect the one time I tried them).

Hehe, as far as alcohol is concered, come to Louisiana. You can buy wine, beer and hard liquor when you buy your gas. Oh, and yes, we DO have drive-through daiquiri stores. In fact, there's one near me that is ONLY drive-through. They give you a 32 oz cup filled with the daiquiri of your choice. It has a lid on it and the straw is NOT in the drink. This makes it not an "open beverage container". In Alabama, while in college, you had to plan for your parties if they were on a sunday. You couldn't buy any alcohol on sundays. Yeah, that makes sense.

Yes, this is what is happening. There is the idea that patients must be "protected" against themselves. So we entrust the patient's care to doctors who:

#1 Don't have to live with the situation and may, in many cases, are less informed about it than their patients.

#2 Have interests other than the patent's care.

You see, the patient is not allowed to care for himself. This is "for his own good". Collectively, our society as decided that we are too stupid, untrustworthy, and incompetent to be entrusted with the care of our own bodies.

People relinquish these freedoms because the feel they can then be free of the responsibilities and consequences of making bad choices. Our society is the result, and insurers against malpractice claims are the ones who end up dictating policy because they foot the bill.

In my view of a moral world, people would own the consequences of eating something (whether its flexoril, alcohol, opium or marijuana). There would be nobody to sue, because everyone would recognize that there is nobody else to blame. We would allow people to make decisions that were different than the ones we would make in the same situation, and then we would require that people lived with the results.

The sad truth, articulated brilliantly in Erich Fromm's Escape from Feedom, is that people -- prehaps especially American people, don't want to be free because freedom means living with the results of bad decisions.

The one thing that everyone seems to agree upon, Democrats and Republicans alike, is that the state should be everyone's big parent. All of the major political arguments of today are simply arguing about what kind of parent people want. Nobody seems to question the underlying idea that it is OK to use government to impose one's own point of view on others. Almost everyone completely accepts this. The Left wants to impose one kind of world, while the Right has a different vision. Both believe in the same fundamental idea that is about as un-American and anti-freedom as you can get. From my point of view, they are idealogically identical, differing only in the details.

Well, I've had enough of it. Its gone too far. It's time to start having another political debate: What gives you the right to impose your morality on me?

Don't tread on me!

No, of course not. My view of the world does not have room for negligence or harming others.

I am talking about how people treat themselves.

Jim

Interesting book recommendations, thanks! They remind me of some literature I've heard of that claims it's possible to cure most eyesite problems without glasses.

On the back pain subject, a friend's wife decided to go against her doctor's advice to have surgery for her back pain (after which, best case scenario, she would likely need a cane for mobility). She chose some non-invasive procedure, and she's now running around chasing her children.

Some days, I just have no faith in doctors.

FYI, Flexeril an be bought over the internet. There are two basic ways:

1. Order from a US site. They'll make you fill out a form which supposedly goes to a doctor who you writes you a prescription. I doubt there really is a doctor involved but they make a show of following the law. You'll get an FDA approved drug from a US pharmacy.

2. Order from an overseas pharmacy where they don't make any pretense of involving a doctor. This will likely be cheaper - sometimes by a lot. What you'll probably get is a generic made by an overseas company that isn't FDA approved. I'm careful who I order from and my experience has been good.

www.drugbuyers.com is a forum where people discuss these places and which ones are reliable. It's an interesting forum because you find the full gamet from recreational Vicodin addicts to responsible people who, for reasons like yours, have decided to take control of their own medical treatment.

Quote:
I was having pain in my right leg. I couldn't explain it. It became more chronic, and more severe. I tried to determine if it was related to some repetitive stress or some activity I was doing. It didn't appear to be.

I went to my doctor, who suspected this might be cyatic pain. He suggested I get a CT scan of my lower back to confirm his diagnosis. This made sense to me, so I chose to get the CT scan. It showed the damage he suspected. He then put me in touch with specialists to help me understand my treatment options.

and

Quote:
You see, the patient is not allowed to care for himself. This is "for his own good".

I’ll offer a defense of the medical profession (and a disclaimer: I am not a physician but a lot of my relatives are, including my grandfather who was the chair of surgery at Duke for many years).

Beyond the training in anatomy, injury and disease, tests and scans, drug actions and interactions – all those things we think of when we think of what doctors do, doctors are trained to observe, and to observe nuance. This goes beyond just hearing what a patient says about their symptoms; they see things and ask questions that may not occur to a patient – the leg pain that’s really a back problem.

The body is a very dynamic system and we compensate for its changes over time. Chronic pain can lead to poor posture, which can lead to other damage. What a physician saw 10 years ago may well have changed. Frankly, I’m surprised your doctor let you go that long with a “med-check” visit. Yes, in your case, it might not be warranted, but the physician can’t (ethically) decide that over the phone.

-jk

Yes, I realize there are ways around the law. We as a society even seem to think that it is OK to circumvent the law. Why don't we have the cojones to take the next logical step and admit it is an irrational and immoral law? Isn't this a lot of effort because we won't simply admit we are wrong?

This attitude leads to selective enforcement of laws (resulting in institutional prejudice and racism), lack of respect for rule of law, and a host of other problems.

I'm not disagreeing with you. I will probably go to one of these grey market alternatives. My point is that I shouldn't have to.

Jim

I understand all of this, and I think its a good point. It misses my point however, that it isn't morally the doctor's choice. It's mine.

Again, in my fantasy view of the world, the doctor would not be required to get this medicine.

On the other hand, in my fantasy world, I would continue seeing a doctor every couple of years for checkups, etc, because I respect and appreciate the education and experience you describe. Since he knows me, and keeps records on me, he would ask me how my back is doing, etc... Again, it should be my choice whether to seek his counsel. I would, because I know he's dedicated many years to developing his craft and he has insights I can't have. This is the same reason I would hire an attorney. I am not *required* to get an attorney, or an accountant, but many would say its probably a good idea.

I did see this doctor every 2 or 3 years for a physical, or for some other reason (sinus infection or whatever). I'm pretty healthy, so I didn't see him every year.

I really don't know if I can bring myself to seeing him again. I don't trust that my interests come first.

Jim

I think there's one other aspect of this issue that's not been addressed yet in this thread.

The role doctors play is not only ostensibly for the benefit of their advised patients, it's also to create a system whereby non-qualified people are explicitly barred from offering 'expert' advice on medical issues. While I can't disagree that nobody knows how your body reacts to substances as well as you do, I'm damn sure that non-doctors certainly don't know as well as doctors how well these substances will affect others. Were we to go to a non-regulated/minimally regulated marketplace for physio/psychotropic substances you would have legion such 'experts' dispensing cut rate advise.

There's a good deal of danger in the 'witch-doctor'/anecdotal advice approach to medicine. Is there possibly some up-side? Perhaps, but there are certainly some drastic downsides that outweigh any such upside (such as death from mixing incompatible medicines).

-Zeke