With one exception, I received nothing but praise for my recent piece on U.S. opioid history and policy. But that does not mean the exception has no merit! It came from Matthew Holt who conveyed that it lacked acknowledgement of “the role of Anslinger & later drug warriors, and the racism involved in opium bans.”
He’s right. Likely Matthew is a greater expert on these matters than I am, and he pointed me to one of his earlier pieces that touches on the subject.* It’s about the, apparently nearly completely groundless, prosecution of Dr. Frank Fisher who prescribed opioid medications to poor patients in a rural California county.
Meanwhile, what do you think happened to the patients at his clinic, which was destroyed by this action? Go read the full interview with Fisher at DRCNet, but this is an extract about what happened to the people he was serving. As you might have guessed their transition from his care to that of others in that rural underserved area was not exactly smooth.
In the extract, Fisher is quoted,
The availability of pain management for poor people is even worse than for the rest of us. And it’s not good for the rest of us. Everyone who develops chronic pain is likely to be killed by it because of medical neglect. It’s a malignancy in the sense that if it is not controlled, it will spread and progress. My patients were effectively tossed out on the street to fend for themselves. The local medical clinic saw them as drug addicts who needed to be detoxed.
Had I done more research in this area and folded these themes into my piece, I’d have drawn a fairly similar conclusion. Narcotic painkillers remain both problematic (addictive, subject to diversion) yet opioids have some worthwhile uses (for pain and addiction treatment). These alone present substantial policy challenges. If the implementation of policy (whether good or bad) also has an implicit or explicit racial bias, that’s no less worthy of our attention.
* He also pointed me to this other one, but the link didn’t work as of the time I wrote this post. It does now. You can click through and read it for yourself. It’s short.
UPDATE: I removed Matthew’s full tweet and made some edits to accommodate that removal, as it included some criticism he later retracted.