Drug History Canada

So today in response to an interview I had on CBC and some tweeting that was going around some mysterious person stated “The human body is not meant to be pain free.”  I refuse to engage in troll-y debates, so I figured I’d do what I promised yesterday and begin to dig into some of the stories I have learned since the op ed on pain was released last week.

But first a reflection on language.  You often hear the phrase “meant to be” as in “the human body was not meant to be pain free” or “their love was meant to be.”  It might just be a convenient cliche, but when you talk about something that was “meant to be,” you are implying intention and conscious action by some outside force.  So if someone says “that little boy didn’t mean to hit his friend” or “I meant to take my Christmas tree down yesterday” we are talking about an act of intention.  So to say something was “meant to be” is to say that there is a predetermined outcome, or a predeterminer. In other words, you’re saying God meant this.

The human body was not meant to be pain free is an asinine statement that suggests your god wants you to be in pain.  Now, I’m no religious scholar, but even in religion pain is something to be avoided. Job wasn’t exactly thrilled that he was plagued with injury; Jesus wasn’t singing show tunes hanging from the cross.  The very process of The Crucifixion was in itself an act of pain and degradation, and it is framed in Christianity as the process by which humanity is saved by Jesus taking on the punishment that deeply flawed humans are supposed to have suffered.  He “suffered for us.” It’s a fundamental of Christianity, and so pain avoidance is not a problem.

But perhaps this person is really just saying it is unnatural to be pain free. Fair enough, but pain is not a desired nor a normal state.  Pain is an indicator that there is something wrong.  We have evolved to avoid pain. If we didn’t, we would not have likely evolved, since our ancestors would have kept doing things that caused pain and possibly not procreated, and kept the race going.

Pain is, however, natural.  It is that thing in our brains that says “don’t do that.”  So if one were to say “the human body was not meant not be unable to feel pain” or “it is not natural not to feel pain” I’d be in agreement.  But to suggest that feeling pain is a natural state is just silly .

That aside, usually such statements are made by people who are not in chronic pain, have not faced the debilitating blinding pain of people like my friend Lisa I mention in the op ed, and have a “suck it up” attitude based more on a sense of superiority over weak people, rather than any kind of sophisticated appreciation of the dimensions of pain.

The problem is: our health and the integrity of us as physical beings is more than just about living in fleshy machine that gets our brain through life. It is fundamental to our being.  This is why the field of medical ethics and bioethics is so important. Unlike work on a car, or on your house (both of which have different levels of emotional involvement) work on your body affects fundamentally your sense of self.

I invite such people who shrug off stories of pain to get heart surgery without anaesthetic. Or, less vindictively, I will reproduce some of the stories I’ve received about pain.

Let’s get the less challenging stuff out of the way first. One correspondent thanked me for my “supremely intelligent essay on pain – a problem I share with a great deal of life-destroying intensity.”  Life destroying intensity relates to that sense of self, and the reality that quality of life is filtered through our experience with a body in pain.

Something more heartwrenching came in a few minutes later

Normally I am up @6:00 a.m. But today slept in until 8:30 because of a brutal pain attack which 2 naproxen, 2 tfa, ointment, heat, cold did not alleviate.

My output today will be well below normal but I will find my way to my Chinese doctor for a foot massage.  I will be 80 next Friday but still active… and have endured pain for nearly three decades. My Doctor who doesn’t do pain didn’t prescribe Naproxen until I brought it to her attention five years ago.

As I lay sleepless last nite, some times screaming out (some distance from my wife so I wouldn’t bother) I wondered why can’t I get opioids to ease the pain?

So thank you for your help.

This was a difficult one, a personal story of endurance and the persistence of pain. Screaming out in pain at night, avoiding close contact with his wife so he wouldn’t disturb her, and a gap in medical knowledge.  A doctor who “doesn’t do pain” is a startling concept.  .

The final one will be difficult to anonymize, but I will try.  It is about an individual’s family member. I use the acronym AB for this person.

Fifteen years ago AB was given benzoes and high dose painkillers (Percocet)  for CFS [chronic fatigue syndrome], fibromyalgia and anxiety disorder. AB has lost [his/her job] and is on long term disability.

Recently the B.C. College of Physicians and Surgeons, in a very crude and sledgehammer approach , dictated that no Dr.s shall prescribe OxyContin, something AB was switched to from Percocet. So AB has had to try and go cold turkey. Even finding a Dr. at one of the walk in… clinics is next to impossible. Most have signs stating unequivocally only one problem per patient! Ten minutes at most for any medical advice. How AB will end up is a constant worry for us – and more so for AB.

Pain is pain and cannot be just ignored because of a dictate by the esteemed medical community. The edict by the College ignores thousands of people suffering from real, life changing pain.

There are several elements of this story that reappear elsewhere. Problems with understanding of pain management, access to consistent medical treatment, sweeping directives that leave many people in an untenable position.  I should note that the BC College “edict” is explained by the college as guidelines, although it has some rather punitive fines for doctors who run afoul of the system.

Pain is something we try to avoid. Pain that is persistent is distracting at the least, debilitating at the worst.  You may be able to limp along on a strained ankle, but if there is no way to ease that pain, if you can’t sleep because of it, if your relationships are strained, your work is lost or diminished, your opportunity for advancement curtailed, it is more than an inconvenience.  Pain is a fundamental feature of our life; it is what helps keep us safe, and avoiding it is something we all try to do (even sadomasochists have safe words). But when we can’t avoid it, when the control over the fundamental integrity of our body, the one thing we truly possess is lost, it can strike to the core of our being.

So don’t tell me pain free is an unnatural state.  Having no empathy for people in chronic pain is unnatural.

But before I click “publish” I want to make something clear. My discussion of pain is not intended to justify pain medication.  There are many ways to address pain that do not involve pain medication. However, medication can be part of a pain strategy.  and some types of pain need certain types of medication. Long-term therapy helps, but we should not reject the need for a pharmaceutical intervention due to stigmas of addiction or dependence or at just some kind of ideological rejection of the pharmacomedical industrial complex. Pain management, just like the issues of addiction, is a complex process requiring thoughtful consideration of multiple factors.

If the weather holds I’ll be off to Saskatoon tomorrow for a symposium on cannabis legalization.  I have been asked to do a keynote based on my observations and research on the connections between liquor control and cannabis legalization.  It’s something I have looked at a few times, so it will be fun to bounce these ideas off an audience in a city where cannabis has been an especially hot topic of consideration and debate for a while now.

Here is the poster. If you’re around, come by.

Just an update on the cannabis file. There has been considerable interest in this topic since, well, the past few years I suppose. But after the Liberals came back to power, with Justin Trudeau making a clear argument for legalization, not just decriminalization, the attention has been ramped up.

I’ve had a chance to speak to the media quite a bit on this, and several articles have come out about the topic.

As a historian, of course I take the long view. I relate current cannabis legalization challenges to the challenge of legalizing liquor after prohibition. These views have come out in several pieces in the past little while

First, I’ll let my ego soar and mention articles that I’ve written or been involved in:

Toronto Star‘s Chris Reynolds 22 Dec 2015

Prohibition: A history lesson 

My Op ed on this topic from 15 Dec 2015 The Globe and Mail

Why should liquor control boards sell cannabis?

My op ed in National Post over a year ago (5 November 2014)

How to legalize pot?

Of course there is more, and some of it does not take a historical focus apart from looking at the last few months or years’ experiences.  These are important perspectives, but a longer view gives us more insight.  After all, both the Colorado and Washington state regimes are still being established.

So consider the following documents

Centre for Addiction and Mental Health releases its policy framework supporting legalization based upon harm reduction principles

Canadian Medical Association Journal advocates a similar perspective but is much more circumspect.  If you can’t access that material (it may be behind a paywall) then check out the CBC’s coverage here 

My concern with this editorial was this fixation on “big cannabis” which rhetorically links it to other industries presented as conspiratorial and out to mess with the public’s health, such as “big tobacco” and “big pharma.” Let’s leave the rhetoric aside, since it does nothing more than perpetuate myths that may not be valid.

Yet although I advocate cannabis legalization (and note, I have never smoked the stuff and have no interest in consuming it in any way) I should note that there are many voices of caution. I’m not going to post them all, but a quick jump into the newspapers will reveal a range of angles.  As a caution, remember to read through the rhetoric and into the evidence.

Here is a good example of rhetoric trumping content, as presented in the Toronto Star also on 22 December.

More young adults in Ontario would smoke pot if feds legalized drug: Poll

Pretty alarming title, huh?  And given that many people may see this on the front page in large type it could sway opinions.  But read on.

The president of Forum Research, which ran the study, noted that “He noted that overall, it doesn’t appear that legalization would prompt a sharp uptake in marijuana use.” Moreover, he said “When you look at how many are using it now and how many would use it when it’s legal, it’s not that many people at the end of the day.”

Yet the Star’s title, histrionic as it is, suggests something more dire.  It is literally correct, but does not provide anything like the nuance that the study found.

I’m not surprised (and wrote to the Star about this, a letter which appeared 4 January 2016) because the Star is historically a prohibitionist paper.  That angle persists, just manifested in different ways.

While we are talking about rhetoric, I’d like to point out the rhetoric of opponents. This is the problem I find, that people internalize the intense moralism of those who disagree with cannabis legalization. Like the temperance forces a century ago, they write as if the substance itself will bring down Western society.

After my op ed in the Globe, I received the following letter:

I’m totally shocked that you have allowed yourself to be brainwashed by potheads’ lies and propaganda.

Pot is definitely more harmful than pot. While cigarette smoke harms only the lungs, pot smoke harms both lungs and brains (especially young brains). And cigarettes don’t cause impaired driving resulting in injuries and deaths, like pot does.

According to columnist Michael Den Tandt, “Data gathered by the Rocky Mountain High Intensity Drug Trafficking Area (Colorado), established to monitor the effects of legalization, shows a dramatic increase in impaired driving due to marijuana. In 2014, according to a report released in September, the rise in pot-related road deaths was 32 per cent. From 2010 to 2014, the rise in marijuana-related traffic deaths was 92 per cent, compared with an eight per cent increase in all Colorado traffic fatalities over the same period.”
http://news.nationalpost.com/full-comment/michael-den-tandt-dont-be-surprised-if-marijuana-legalization-gets-shoved-to-the-back-burner

For more news, articles and info about the harms of pot, visit: http://harmsofpot.blogspot.com

And the much-ridiculed old film “Reefer Madness” has been proven to be truthful and correct after all by news and evidence.

I was so excited to have someone engaging in my editorial that it took me a while to write the following response (originally I’d decided not to engage, but how could I resist?):

Thank you for your interesting message.

I’m not sure where you’re writing from or what aspects of my recent discussion on cannabis legalization you’re responding to and choose not to engage you beyond pointing out one thing.

You may wish to look beyond blogs and journalists for your evidence.  I prefer getting my information from respected sources written by researchers whose jobs it is to ask critical questions and then look at the evidence available, like CAMH, or the Lancet, or the CMAJ, all of which come out in favour of legalization due to the way it will reduce associated harms.

I don’t think these peer-reviewed journal article authors are “potheads” nor that their evidence can be called “propaganda.”  I think they are critical scholars who also seek to figure out if a perspective is supported by evidence or not.

I am also not a pothead. I don’t smoke the stuff, never have, and never will. I find people who smoke pot boring, and the smell is disgusting.

I’d rather have a beer.

What I didn’t point out is the fun you can have with stats.  If deaths rise from 2 to 3, that is a 50% increase, but only one additional death (not that any single death should be acceptable, but again, we’re dealing with histrionics). If deaths rise from 1 to 2, that’s a 100% rise.

That said, the RMHIDTA data deals with larger numbers, but the meanings behind those numbers are shaded with caveats about limits to data and the way it’s reported. this, of course, is lost on the correspondent, and also on Den Tandt, the National Post article’s author. (BTW, the RMHIDTA is a passionate anti-drug collective of policing agencies, so don’t expect their stats to be clear or unbiased.

The story is always the same: dig deeper.  

Be critical.  Always.  Ask where the information is coming from, and whether it makes sense.

That also applies to the information I provide here.

After all, this is just another blog.

(c) 2016 Dan Malleck

Smoking is considered a pariah activity. Smokers, driven by “Clean Air” laws, zealous public health advocates and self righteous non smokers do their thing on the edge of activity. Back doors, 9 metres away from doors, unsheltered, cowering, hiding, heads down, grimaced.

This is how health messaging becomes moral shaming. I’m not a smoker, find the habit gross and stay away from smoke, but the overly evangelical approach of the public health advocates to shame into submission the few smokers of the world really bother me.

It is this biopolitical stance, the idea that you internalize the messages of the state related to your body or health in general, that informs other aspects of health messaging and health politics in general. So it is no surprise that when the Supreme Court of Canada agreed (unanimously) that it is unconstitutional for our medical marijuana laws to render illegal all forms of marijuana except in its dried form–marijuana you normally smoke (ie: brownies, marijuana tea, etc still illegal) some people got pissed off.

CBC on Supreme court

You see, smoked marijuana is the most reviled form. It’s kind of gross, and every picture you see on the media of people smoking pot have some unshaven pursed lips sucking from a filthy crumpled spliff. It’s right up there with those gross pictures on cigarette packets: a repellent disincentive to smoke.

The Supreme Court seems to be immune to the aesthetic sensibilities embedded in public health messaging. Indeed, the justices to a person decided that this “dried only” provision unnecessarily hindered the reasonable access to a useful drug.

To be clear, the ruling was about the clause that makes only dried marijuana permissible for medical marijuana, but the main way to consume dried marijuana is by smoking.

And smoking itself, along with its aesthetics, is perpetually connected to the idea of carcinogens or other toxic elements in the product being smoked. So it is an easy leap from something being smoked to believing with little evidence that that item causes cancer.

The Tories are not happy. Health Minister Rona Ambrose is “outraged.” Of course she is. Their mission with respect to drugs has been to return marijuana to its illegal status, so a ruling that makes it more accessible is outrageous in their eyes. Don’t be swayed by her arguments that her outrage comes from perspective that only Health Canada can decide if something is acceptable as a medicine. The court is not changing the medicine; only the mode of ingestion. Indeed, it’s about access.

Smoking is gross, and possibly the thing that keeps a lot of people from taking pot. I’d never smoke it, but once in Amsterdam I did have these less than delicious but oddly satisfying cakes. (Ultimately I wasn’t happy with the experience, but it made it literally palatable.)

But, I get it. The concern is that marijuana is a gateway drug, and that restricting medical marijuana to its smoked form makes it a narrow and rather unappealing gateway. Well, not to be concerned. The legalization of marijuana has shown that the gateway theory is bunk. So there’s no gate to make ugly.

Today is good news for those of us who think the drug laws are overly restrictive and not very useful. And the fact that it’s another decision that shows the Tories are out of step with the basic elements of our constitution is just icing on the space cake.

There is a lot of attention to the issue of legalization of marijuana. So I wrote a little op-ed. It was published today. I have to say the editors came up with a much better title than I had given it. It was so forgettable, I forget my title.

How to legalize pot? We figured this one out a century ago.