The great irony, which Wailoo does not miss, is that deregulation and government retreat allowed the pharmaceutical industry to expand, virtually unchecked, to meet the demand for analgesia—in turn creating new clinical criteria for pain, new opportunities for treatment, and new markets for drugs. The pendulum swing was extreme, abetted by a growing sentiment in the medical community that doctors had been unduly constrained by the War on Drugs, and that a crisis of undertreated chronic pain was at hand. By the early 1990s, in the era of Bill “I feel your pain” Clinton, “the question of relief (granted or denied) was being reframed as a legal question of malpractice, as a moral question of medical duty, and as a political question of patients’ rights,” Wailoo writes.
Rush Limbaugh’s revelation, in 2003, that he was addicted to OxyContin “shed light on the exuberant drug market that regulatory reform had produced,” Wailoo writes. “[B]ut OxyContin’s rise also forced both liberals and conservatives to look closely at the world they had made—a marketplace that claimed to solve Americans’ problems far more efficiently and completely than government programs ever could, but one that also had the capacity for great harm.”
In 2009, 257 million painkiller prescriptions were dispensed in the U.S., according to a White House report. The CDC estimates that 12 million Americans abuse prescription painkillers, which are now prescribed for everything from minor surgery to end-stage cancer, as broader definitions of “chronic pain” have led to an expanded market for opioids. Of those 12 million, the CDC representative at the Hackensack symposium reported, a small but increasing number appear to be turning to heroin—a cheap, potent, and abundant alternative to legal narcotics. Between 2007 and 2012, the number of past-year reported heroin users in the U.S. nearly doubled, from 373,000 to 669,000, according to federal surveys.
Our healthcare system has not proved particularly adept at balancing the needs of an aging, aching population against the market forces of a booming pharmaceutical industry. The result is gaps in treatment, a glut of pills, and a landscape of addiction—the inevitable consequence of what Wailoo calls our “unquenchable appetite for relief.”
If that sounds like an echo of Reaganite scolding, Wailoo’s analysis suggests an unexpected social twist. Who would have predicted an uncanny parallel, in both political language and morbidity, between America’s “right to relief” pain culture and its tough-guy gun culture? Yet charges of “negligent marketing” leveled against drug companies in the last decade came on the heels of similar legal opposition to the marketing and sale of firearms. These challenges share an underlying logic: Unchecked access to pills enables drug abuse, and unchecked access to guns enables gun violence. Industry responses line up, too. Pain management specialists and pharmaceutical interests decry any regulation of analgesics as roadblocks in the way of due relief for ailing Americans, much as the gun lobby adamantly object to limits or controls as infringements on the right to bear arms. Manufacturers of guns and drugs alike argue that “bad guys”—criminals, the mentally ill, addicts—undermine the reputations of good products. But in both cases, it is the poor who suffer most, disproportionately afflicted by violence, addiction, and neglect.
Americans are simultaneously overmedicated and undertreated. Despite the promise of relief through pills and significant medical advances, effective and nuanced care for pain continues to prove elusive, and prohibitively expensive. While some suffer, others are overdosing at alarming rates. And society’s tolerance for addicts is about as generous as its tolerance for pain. The high school football player prescribed OxyContin for his neck injury is an object of sympathy; once hooked, he becomes an object of scorn.
Articulating a “right to relief” that amounts to more than mere access to pills is likely to mean taking care out of the courts. It surely entails understanding health care as a matter of more than insurance coverage. With the Affordable Care Act still contested in courts, beginning that difficult process seems remote, if not impossible. Nor is there any promise that pain, even if it could have been prevented, can always be assuaged. For Elaine Pozycki, the mother sitting in the back of that New Jersey conference room, the meaning of pain has evolved. Her experience began with her son’s injured shoulder and his three-month supply of OxyContin. While her son’s story ended with heroin, her painful journey continues. “The pain is unbearable,” she told the audience. “And yet it is born to be endured.”