‘Entire Body Is Shaking’: Why Americans With Chronic Pain Are Dying, NYT [trigger warning - discusses suicide]

Can we just give people with intractable chronic pain as much drugs as they want? They're in pain for heaven's sake. (That's slightly hyperbolic.) I see multiple arguments in favor of liberalizing the rules around painkillers:
  • Doctors/policymakers are demonstrating a basic failure to apply the golden rule here
  • People with chronic pain have the right to make their own medical decisions, including making tradeoffs between comfort and the risk of dependence according to their personal values.
  • Distorted evaluation of outcomes. Forcing people to kill themselves, not because of despair, but because it's the only way to end their pain, is implicitly acceptable. A few people becoming addicted to drugs is implicitly treated as more tragic.
  • We're treating molecules as the problem here, not how people use them.
  • Treating addiction as a moral failure. It's not.
  • Addiction would not be nearly as tragic if we had extensive harm reduction.
 
To give a flavour of what the article is about, here are the first 2 paragraphs:

Anne Fuqua keeps a list of suicide deaths. She’s chronicled hundreds of cases of chronic pain sufferers who have killed themselves after losing access to opioid medication since 2014. Recently, she almost became an entry.

Ms. Fuqua, a former nurse, has an incurable genetic disorder that causes ‌agonizing spasms and shaking. She can only function when she takes opioids. She’s one of the estimated five million to eight million Americans with chronic pain who regularly rely on them. But in November, her doctor’s license to prescribe controlled substances was suspended by the Drug Enforcement Administration — marking the second time she’s been left to fend for herself to avoid pain and withdrawal because of law enforcement action against a pain clinic.
 
Meanwhile, we are currently in the golden age of psychosomatics, with all chronic health issues, including pain, having been reframed as behavioral problems that everyone could avoid if they weren't so stupid and just thought differently and exercised a bit.

Not a coincidence.

Just as it is noticeable that there is talk of a growing crisis of mental illness, real or misleading, right alongside massive growth of mental health care and awareness. More money is being put than ever into "mental health", billions and billions every year, and yet somehow outcomes appear to be getting worse and worse. At least according to the mental health care industry, whose only conclusion is that more money and research should go their way.

Also not a coincidence. Conceptual errors guarantee failure in outcome. You get the same level of failure as framing poverty as spiritual failure.
 
I have read a few things recently, both in articles and novels, which I have found appalling. They go like this - someone has become addicted to antidepressants or painkillers, they tried to get "clean" but kept relapsing because the pain or depression returned when they stopped the drugs.

That used to be called medicine.
 
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