Capital of Pain

There is no clinical way to measure pain or its absence. You have to rely on confession. Luckily, trouble and pain make talk easy. Medicine seems increasingly defined as relief from pain, or at least that is how we know medicine best. The modification of time is the goal of pain relief: If I forget my pain, it does not exist. After all, I have been quick to forget yours because I am always told that it is apart from mine. You cannot work with the reality of pain because it has no place, even though we feel our bodies sharpest when in pain. There are only ways of saying it, this strange painful present-tense.

Enter Dr. William E. Hurwitz, the subject of Eve Marson’s engrossing documentary Dr. Feelgood: Dealer or Healer? – and either Gabriel or Azriel, depending on who you listen to. Hurwitz was Ivy League (Columbia, Harvard, Stanford too), practical (a stint in the Peace Corps, Brazil), and down to earth (he worked out of a small clinic). In 2004, he was convicted of pushing pain relief in the form of many thousands of opium-derived pills. Opium and its children – heroin, Dilaudid, morphine and many others – are the most powerful ways of suspending pain this side of life. Hurwitz got 25 years.

Many of Hurwitz’s patients turned their large prescriptions into surplus value. A higher dosage demanded a higher premium, so patient-addicts needed more pills to sell in order to buy more pills and so on. Since only an amateur dealer does drugs, the amateur usually ends up either dead or in jail. The trail of terrified informants and overdoses lead back to the clinic, Hurwitz’s among many. By this time, the OxyContin Scare was in full swing and a media show-trial ensured him a verdict of conviction for trafficking. It was overturned due to the shoddiness of the case in 2006; he was retried, found guilty, and has since been released, license permanently revoked.

Dr. Feelgood arraigns all the familiar suspects. A reel of ads from the legal days of narcotics gives us a charming one-page for heroin, courtesy of Bayer. Bayer was always at the forefront of pharmaceuticals. It invested a great deal in chemical research in Germany and its parent company I G Farben introduced the pesticide Zyklon B to about one million people in the early 1940s. OxyContin is the property of Perdue Pharma and is related to Oxycodone, an opioid created to fill the vacuum after poor Bayer was forced to stop selling real heroin in 1917. Its nickname, ‘hillbilly heroin’, shows just how illiterate the mass media really is. Heroin has always been a cheap drug, easily available to the working class in dime bags, kept affordable for reasons of national security (narcotic ghettos mean sleeping ghettos; safely, for some). If anything, OxyContin is a gentrified property whose rent plummeted due to oversaturation in the marketplace thanks to Perdue’s relentless PR campaigns. It is only natural that it would hit the streets to compete with heroin and, unlike methadone for example, you can shoot it up.

The wealth extraction which follows our working life does not give up the body when work and life really start to kill us. Unhealth is a major cash cow. A new drug appears, is quickly passed by the FDA, and is then lauded as a miracle (cures proper have given way to drugs that merely claim that we’ll be able to cope). When the full spectrum of side effects comes to bear (happily this will take decades for some lucky companies and their meds), the whole therapeutic consortium falls apart and the cops and law courts are inevitably involved. By then, large numbers of people have already died and pay-outs are merely a fraction of the yield Pharma had accumulated before the roof fell in.

As OxyContin was easily available from doctors, it was able to penetrate areas and classes more difficult for the heroin market. It is obvious why the courts and law enforcement began to take notice of it. According to a cop in the film, it ruins ‘good families’. Doubtlessly true, which means its ‘personality’ is more duplicitous than honest heroin, which only ruins those already ruined through poverty (or success, in the case of the odd celebrity). The same snag hits serial killers when they mistakenly kill a college prep girl instead of the usual prostitutes who are, after all, also targets of the law. At this point the extremities of both men and chemicals become unconscionable.

Every few months a new drug epidemic is announced by the usual crowd of experts, moralists, and terrified Congressmen, each one more insidious than the last. You might recall Angel Dust, but few remember the Great Jimson Weed Scare of ‘97. Variety and availability are examples of the dynamism of capitalism and the killing of a Pablo Escobar could be seen as a Neocon strike at price controls with the attendant disaster of the product’s bloody search for a ‘natural price’. If one drug becomes too expensive or too scarce, another will surely arise to take its place. Readers of Das Kapital may recall that De Quincey also wrote on economics.

An important footnote in the film is one Dr. Russell Portenoy, the man who opened the floodgates for mass-volume painkiller prescriptions by his classic 1986 paper with the catchy title Chronic use of opioid analgesics in non-malignant pain[1].  Before this watershed, we were in the grip of one our periodic narcophobic fits. According to Portenoy, higher pain decrees higher dosage. Earlier data on addiction had created an unnecessarily dour picture of life-long dependency. Portenoy’s thin 36 case studies proved that this was all wrong: the Docs should scribble like Proust; addiction was purely a loop in the brain, genetic in 1 out of 10 humans. Despite the often-touted rigors of scientific research, Portenoy’s (complaint) seems to have won over a vast community in record time using no hard evidence at all. Or the hesitant pens of doctors must have hit the opium products divisions of the great drug supply houses especially hard that year. Ask the angel….

Portenoy now admits that he underestimated the power of addiction – his Greenspan Moment, one presumes – in the grim face of some 16,500 prescription ODs a year, outnumbering the feral street kind. Who tallies this kind of information, I wonder, and how? Where did the grants come from for Portenoy’s original study? Vide The Wall Street Journal, Dec 17 2012:

“In 1998, the Federation of State Medical Boards released a recommended policy reassuring doctors that they wouldn’t face regulatory action for prescribing even large amounts of narcotics, as long as it was in the course of medical treatment. In 2004 the group called on state medical boards to make under-treatment of pain punishable for the first time.

That policy was drawn up with the help of several people with links to opioid makers, including David Haddox, a senior Purdue Pharma [manufacturer of OxyContin] executive then and now. The federation said it received nearly $2 million from opioid makers since 1997. . . .

A federation-published book outlining the opioid policy was funded by opioid makers including Purdue Pharma, Endo Health Solutions Inc. and others, with proceeds totaling $280,000 going to the federation[2].”

There is very little to say beyond that. All the loose ends are tied up.

Dr Feelgood examines the case of Dr Hurwitz with great balance. There can be no question that he made unbearable lives more than bearable, that he merely supplied the street with what was generously supplied to him, that he probably made little money on the enterprise (Unlike Perdue: $3.1 billion from OxyContin alone in 2010[3]), that he wanted to ease the pain in others, that he lead more than one dope fiend to their grave. Hurwitz maintains that his job was to alleviate pain, no matter the patient. Damning wire taps show that he probably knew some of his patients were selling the stuff. His story is a locus of hypocrisies and indifference, all of them official and all of them untroubled in sleep.

Our bodies are the only pain we can call our own; the mind has never truly had a location. As what is left of our gutted medical coverage withers away, do not doubt that the market and its double will come to our rescue in our most agonized moments. Like everything else, speculation runs the show from the back while Angel Azrael works the corner on foot. The patient can hope for very little under the present circumstances, with the present interests running wild.





Martin Billheimer is the author of Mother Chicago: Truant Dreams and Specters of the Gilded Age. He lives in Chicago.