By Richard Nash Creel

The op-ed by Ada Fisher titled “Drugs are out of control” (June 27) leaves much to be desired in informing the public and offering approaches to dealing with the number of drug overdoses, of narcotic analgesics. Through media-generated and political hysteria, the results of widespread use of opiates/opioids to relieve chronic pain have led people to overlook the factors of stupidity and irresponsibility that inevitably occur in a culture given to gross excesses (that of the United States). Apart from the  simplistic preachments about self-indulgence (easily said but applied in practice with difficulty), there are statements, made in the spirit of dogmatism rather than a regard for the truth and, in one case, what struck me as a tendency to, if so applied, sadism.

First, the advertising of medicines today, part of an obtrusive presence on TV, the Internet and printed materials where advertising goes, derives from the increased size of the pharmacopea from times not so long ago when many useful agents for blood pressure, angina, hypercholesterolemia, hypertriglyceridemia, SSRI agents, advanced anti-inflammatory drugs, slow-channel calcium blockers and anti-secretory drugs (omeprazole, cimetidine, ranitidine) did not exist and treatment options were limited. In the early ’80s, I was informed by a detail man that two medications for allergy, then available only via prescription would, at the manufacturers’ request, be made OTC due to generic competition. Likewise, the agents used for gastric and duodenal ulcers that emerged first with cimetidine at the end of the ’70s, became, as the patents ended, interestingly, available in 1/2 doses, also OTC. It’s not just advertising, people, but availability, and what drives this: business considerations instead of public weakness.

What I find extremely offensive and even disgusting is the suggestion of mandating controlled drugs to a one-week supply. Phenobarbital is a schedule IV agent for epilepsy. What happens after the week is out? And what about those who have ongoing chronic, even very severe pain? From a terminal condition? One Internet site gave 100,000,000 as the number of sufferers of chronic pain in the US. Not all are treated with narcotic analgesics, and they may find relief with gabapentin or such agents as ibuprofen, indomethacin, diclofenac or the cox-2 inhibitors. This number does merit some consideration and compassion for those who do so suffer and protection from the burocratic meddlers and other self-righteous activists who would, as so often is the case,  do much more harm than good.

For detoxification, is voluntary compliance a realistic and viable option, or is this as useless and misguided as the “just say no” approach to drugs and sex from the ’80s? That really helped a lot!

And finally, among the many bombastic edict-like offerings in this abomination of an article, there is the order (certainly not a suggestion) to put pressure on nations that export drugs. This is a riot. And what countries are those? Could Afghanistan be among them? And what sort of Americans are over there now, busily “applying pressure”? Does anyone believe that such a policy will be applied to the detriment of international politico-military strategy? I am reminded, on rereading A. Fisher’s article, of the words of an Englishman who said, “For every complex problem there is a simple solution, and it is always wrong.”

Richard Nash Creel lives in Salisbury.

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