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The Politics of Pain


One of the first things I learned in my health care career is that pain is an inherently subjective experience. Different people experience different levels of pain in different situations, and everyone has their own idiosyncratic problem areas — one can’t bear dental pain while another finds back injuries unbearable. Because of this fact, backed up by neurological research, I was taught that we cannot take a cookie-cutter approach to pain management and that each patient deserves individual attention and an individual pain management plan, which is as important an aspect of the overall plan of care as any other therapy.

Our betters in the Food and Drug Administration know better. They know what my teachers and peers did not, and are prepared to implement a nationwide cookie-cutter pain management plan for every single one of three hundred million Americans. In their infinite wisdom, they have decided to make hydrocodone/acetaminophen combinations — the most well-known of which is Vicodin — harder to come by and to require patients to see their doctors — and pay for an office visit, of course — every time they need a refill of these fairly mild drugs.

And mild drugs they are. Opioid pain killers are measured by how they compare to morphine taken orally. Hydrocodone is 1.5 times as potent as oral morphine, which compares very poorly to some of our modern pain killers, such as hydromorphone (Dilaudid) — five times as potent — and fentanyl, which delivered via patch on the skin is eighty times as potent as morphine. And in Vicodin, a mere 5mg of this weak tea opioid is combined with a standard, over the counter dose of acetaminophen (Tylenol) to provide a pretty mild analgesic effect.

But of course it’s not their pain relieving power that concerns our betters. The real issue is that some people use these pills to feel good, and sometimes go too far and suffer for it. No one is shoving pills down anyone’s throat. These unfortunates are taking the pills because they want to, because medicating themselves into oblivion seems like their best option. But in true progressive fashion, rather than wonder what it is about the suffocating state capitalist system that drives people to such fates, our betters in the FDA would rather plunge even more innocents into misery in the name of preventing a few of their victims from using chemicals to escape for a little while.

We can tell it’s pleasure that is the problem, as some of the most dangerous drugs on the market are available freely over the counter even to small children. Tylenol, for instance, sends 80,000 people to the emergency room every year, but it does not make anyone high, so it does not draw the interest of our Puritan masters.

Among the dangers lurking in the doctor’s office and the hospital Vicodin still does not impress — the most lethal thing that happens in our health care system is not people getting high but doctors and nurses screwing up. 98,000 of our fellow Americans die from simple mistakes every year, mistakes often made by overworked nursing staff on inadequately staffed floors run at a substantial profit by politically connected businesses and executives paying themselves absurd salaries. But this too does not exercise our progressive friends, as that most insidious of dangers — people feeling good — is not here lurking.

No, our progressive friends in the FDA and the Obama administration want to save you from the danger that you might use a chemical to feel good, might like the experience, and might want to repeat it. And they will not even blink at the thought of trampling over the care of people in pain to stop us from getting high. Suffering, after all, purifies the soul, while demon pleasures tempt us away from the puritan, progressive path.

Jonathan Carp is a member of Iraq Veterans Against the War and a nurse. He lives in Tacoma, WA.

Jonathan Carp is a fellow at the Center for a Stateless Society ( and a member of Iraq Veterans Against the War. He works as a nurse in Tacoma, WA.

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