My dad recently retired after 30 years of practicing oncology and hematology in a private practice ran with a female colleague, located in an office building adjacent to a very large regional hospital. He also worked a supervising shift in the ER every Thursday night, simply because he found it easier to be in the ER since so many of his patients visited it while he was oncall, sometimes forcing him to go in anyway.
I guess you could say I enjoy recreational drugs and have done them all and my dad generally knows this and we've talked quite a bit about drugs, specifically the insane amount of opiates and benzos he used to prescribe to his cancer patients.
I've sort of gotten the impression the DEA was a hassle in his life and he would not want any attention gained by publicly saying anything but "drugs are bad" (aka the failed war on drugs). There would be no incentive for him to do this on a day to day basis; in fact, there would only be disincentives, at least in the short term.
One day in the early 00s, the DEA showed up at his practice unannounced and wanted to start auditing him on the spot. They told him he was in the top 10 opiate prescribers in his area and they were concerned. They had absolutely no paperwork, so my dad kicked them out of his office, and later the building via security. He told them to come back with a warrant. They never did.
What struck me about this story is how visibly upset he got at the idea of the DEA depriving people of comfort when they are in pain. When he told me this he said, very emotionally, "These people are dying and in pain and they want to look at paperwork?" I can only imagine how pissed off he was when it happened.
This anecdote is all to say I think that doctors probably take one look at any effort to delegitimize the war on drugs and say Nope. What's the point? To help society? Like they do every day as doctors? I just have never felt much of a "let's rock the boat" attitude from any doctors I've known personally regarding drug laws (keep in mind they live in a bubble where all of the drugs are available to them via an Rx pad -- this is very relevant to the enthusiasm drought IMO).
Based on a lifetime of being around doctors as personal and family friends (my mom is a medical doctor too), I don't think doctors are going to pick up this cause enthusiastically, even if it makes sense on paper.
Having gone some surgery few months ago where a miscommunication (let's name it this way) from the nurses about my prescription left one day longer in the hospital, made my cry out of pain and made me afraid of even trying to stand up, I must say that I never understood the idea that "let's refrain giving so much opiates to these patients who have a life-expectancy of few months because it might get then addicted".
I didn't realise this was actually a thing? There's so much craziness out there that I guess it probably is.
However, don't get it confused with over-prescribing opiates to people with chronic but not life-ending pain, then suddenly restricting them again, which many point to as creating a ready market for illegal drugs.
Ideally they'd get less dangerous pain medication, and/or in a controlled manner that prevent accidental or intentional abuse, resale etc.
That's some interesting discussion. Not all drugs act the same on everybody, sometimes a stronger drug won't have any effect while a lighter one (or just slightly different one) might be enough. But there are cases that the lighter one can be eaten like cereals in the morning and won't give you any comfort.
Side effects are also a thing. Sometimes the lighter medication gives you the worst side effects, and I don't think (at least not anymore after my ordeal) that's human not to try and give all possibilities to your patient.
Of course abuse must be considered, resale should be prevented. Some drugs even have a special coating to prevent chewing and breaking so that the extended release drug isn't delivered to your body in some abusive way.
But preventing real, needed patients from getting a good drug because someone else might abuse it isn't fair for those who need.
Actually, the RCC's position would probably be something akin to "feeling pain brings us closer to being like Jesus" or some other such nonsense.
I mean, after all, that was Mother Theresa's outlook (which is why so many suffered under her "care" in terrible conditions - despite her organization being extremely well funded. Mind you, though, that when it came time for her care, flying out to receive proper medical treatment in a first-world country was paramount).
To the contrary, to quote Nixon's aide (Nixon having started the war on drugs):
“You want to know what this was really all about?” he asked with the bluntness of a man who, after public disgrace and a stretch in federal prison, had little left to protect. “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”
If you can still edit, I recommend you move the last sentence to the start of your incredibly insightful anecdote:
Based on a lifetime of being around doctors as personal and family friends (my mom is a medical doctor too), I don't think doctors are going to pick up this cause enthusiastically, even if it makes sense on paper.
Doctors are already fighting the good fight every day -- carrying the fire (the vast majority, at least). I have always mostly lived in a liberal bubble and over my life I'd say 90% of the people I have interacted with often over a long period were liberal, and this extends to 90% of my extended family too. Bubbled in all the way. All of these physicians in my bubbles throughout life have mostly fit the liberal label (except maybe fiscally) and would be more than happy with treating drug addiction like a health problem. And lots already do! Depends on the city, of course.
Things like "ending the war on drugs" are simply not on your average doctors' mind in the day to day (in my experience). They have other stuff to do, like maybe save a life or two, finish that big paper on immortality or w/e, and they simply go right ahead being doctors, knowing in the back of their mind they are largely "above" the drug war anyway, since they can and do dole out narcotics constantly.
To my dad, an 80mg oxycontin (the old ones, the holy grail of opiate pill abuse) lost its status as a "ooooh, awwww, look at this neat pill" thing probably within 60 seconds of becoming a doctor (that's a guess). My mom was/is a psychologist (retired) and doled out narcotic tranquilizers left and right as well (though at the VA, so she got left alone). It happens to pharmacists too, even a pharmacy tech friend of mine would go "meh" at a 1500 count bottle of perc 30s.
The drugs just become part of the day to day like, for lots of HN readers and myself at least, working on tens of millions of dollars with of computing infrastructure is business as usual.
I think the access to narcotics and constant distribution and "above it" feeling is relevant to why I think doctors won't be leading the anti-war on drugs movement. I don't know for sure about many other than my parents and a few others, but I'm guessing they would all end the war on drugs tomorrow and treat it as a health issue if they knew how to do it without making things infinitely worse. And I'd venture to say most doctors I've known over my (liberal-bubbled) life would agree without much thought put into it -- if they aren't already in some small (or big) way.
In my experience, a lot of doctors have already drank too much of the Kool-Aid. Of all my family physicians, only one was willing to have candid conversations about drugs. The rest would just shut down the conversation immediately and say all drugs are bad / we're not talking about this.
Given that the primary function of a physician these days creeps ever closer to "drug prescriber reacting to acute symptoms", this is just dripping with irony. Say no to drugs indeed.
Same experience here.. I come from a family of doctors, and not a single one of them is particularly against the war on drugs it's quite the opposite. This even seems to trickle down to nurses and it's probably as someone else described because they are biased from having to deal with all situations where something goes wrong. Of course you will find the occasional morphine junkie doctor but it's probably not even interesting to them either since they have all the drugs they need available.
Doctors suffer from a kind of bias-- not sure the name of it-- but they only see people when they have problems. The only time doctors encounter the human experience of LSD, magic mushrooms, etc. is when something has gone wrong.
Unless the doctor has spent a lot of time at music festivals, burning man, etc. they
Sure, alcohol is a very dangerous drug, and causes all kinds of ill health, chronic conditions, emergency room visits, accidents, etc. But, because most doctors have had a typical experience with alcohol, from trying it as a teenager, binge drinking at college, and now social/casual drinking, they think it's safe, because they've had lots of experiences that didn't end with someone going to the hospital.
I'm not sure what the best route is for this, but asking doctors to take lead on this doesn't seem like an effective campaign.
By the same token, doctors are better equipped to understand (to the extent we can) the neurochemical reactions being caused by drugs and how they act on the brain. I would imagine a doctor who e.g. understands how many anti-depressants work by targeting the serotonin system would find it interesting the way many psychedelics also are serotonergic - people are basically just dumping analogues of their own neurotransmitters into their brain.
Similarly, look at the relationships chemically between sumatriptan (used to treat cluster headaches), psilocybin and DMT. Or the opioids, stimulants ... substances like coca and kratom that have been used for hundreds or thousands of years and analogues of which are used in medical settings all the time.
The argument that these are crazy, dangerous substances with zero legitimate medical value pretty instantly falls apart to anyone who understands how closely related nearly all of these substances are to pharma drugs widely understood to have legitimate medical value.
I'd in fact be interested to hear which "drugs" have the least relation to any recognized western medicine. Salvia divinorum?
> By the same token, doctors are better equipped to understand (to the extent we can) the neurochemical reactions being caused by drugs and how they act on the brain.
I'm not sure how true that is. The amount of knowledge of (bio)chemistry required by most doctors in their day-to-day work is actually quite limited. A few years out of medical school, and many of them have already forgotten most of what they were taught in medical school, and the medical school curriculum really only gives a high-level overview of the topic.
I'm not a doctor, but my mother and brother are. My mother despite being a doctor will admit her chemistry knowledge is quite limited, but to be fair to her she doesn't need to know much chemistry at all to do her job–you don't need any detailed knowledge of biochemistry to prescribe an antidepressant or perform a caesarian section. My brother by contrast knows a lot about chemistry, but that's not due to medical school, that's due to majoring in chemistry as an undergrad.
This sounds like you at least want to have policy experts or domain statisticians involved. Doctors aren't really in a place to understand whether a policy has failed, but they are in a place to lend credibility as a community that has fostered the currency of credibility. I think you'd be surprised how many doctors don't understand the empirical aspects of medical literature, or any empirical literature.
From a scientific standpoint, salvia should be researched as it operates on the k-opiod receptor and ought to be useful in gaining more insight into consciousness (as anyone who has taken it would attest) [1] There are other opiods mentioned in the Wikipedia article in the same class that are used as pain medication.
From a medical standpoint, I believe there has been some research into salvia's potential use as a anti-depressant, but that might just be anecdotal, I can't recall right now.. [1] points to some clues how this might be the case. Now I remember some research into depression and how it is related to the pain centres in the brain in some fashion - "Tylenol appears to reduce activity in a region of the brain called the “dorsal anterior cingulate cortex,” which research has tied to physical pain and social rejection and ostracism, Randles explains. It’s likely that dampening activity in this brain region accounts for the study participants’ weakened sense of anxiety, though Randles says it’s too early to prescribe Tylenol as a cure for existential distress."
From a psycho-spiritual viewpoint, oh boy. I could go on forever about that and the need to really start getting a handle on this topic (re: transpersonal psychology). But my own experiences (i.e. kundalini, reliably) and what that is like... what is going on, from a scientific standpoint, even if it's all in my head, is very interesting. The brain/mind connection is a lot more complex than we can even think of...
I haven't read the article yet, so I don't know if it promotes the medicalization of psychoactive substances, which is a concern of mine.
Lumping everything under "drugs" (but leaving out alcohol) is really idiotic. There are all these facets, along with sociological aspects, that each substance needs to be considered individually when figuring out a rational way to deal with the problems while utilizing them in some fashion to improve society.
So, no, salvia does have some relation to western medicine.
I sympathize with the OP, although my concerns are slightly different.
I worry that physician groups are trying to shape this narrative in a way that just shifts government-sanctioned power from one group to another. Physicians are not disinterested parties in this, because they have huge financial benefits to gain from official policy being that drugs are a "medical" issue. Once this happens, if nothing changes about the way that the medical system is organized, you'll just have a different group sucking up money and controlling individuals wholesale without sufficient justification.
I agree with you up until a very critical point. Doctors are better equipped to understand the neurochemical reactions being caused by drugs than criminal justice professionals. However, they are not necessarily better equipped to understand the neurochemical reactions than other scientific professionals, nor are they better equipped to understand the economic, social, or legal consequences than criminal justice and other professionals.
This is what is happening with the medical rhetoric: you have a group of experts in area X, who are currently legally designated as either the only people truly qualified, or in control of those qualified, arguing "drugs are an issue of X." In doing so, they put themselves in control of decision-making in this area, with all the financial benefits that accrue to them, and, more dangerously, simultaneously take control of discourse away from others, because then they become the ones who are only, or who are most qualified to make decisions about whether or not it is an issue of X. Once society deems drug use a "medical disease," then physicians become the people who are only truly legally qualified to make decisions about drug use, and also the only people truly qualified to make decisions about drug use policy. It's an entirely self-serving vicious circle.
This line of reasoning is also dangerous, because there is no end to its logic. Given that humans are fundamentally biological beings, any state of human suffering can ultimately be seen as "medical" in nature.
Reading this sounds conspiratorial, and I don't mean it to be, but it's frustrating to me that society doesn't recognize the ethical conflict of interest created by current medical certification and licensing systems.
Don't get me wrong: the current system for handling drugs is woefully broken. But I worry that labeling drug use as a "disease" will only shift the problems from one area to another, unless that system is also reformed to foster a more competitive, less hierarchical health care community. Drug use problems are a complex, social, biological, psychological, legal, economic problem set that is outside the purview of any particular professional community. The best approach is to just deregulate it, and treat it as a form of human suffering that requires a multifactorial approach.
I'm deeply skeptical this will happen, though, given our recurrent need to oversimplify everything.
Except that no one really understands why SSRIs have an antidepressant effect in some patients. We have some hypotheses but the underlying neurochemical mechanism is still somewhat mysterious and unproven.
The full editorial itself is reasonably neutral and well stated. They may be overstating their ability to "build pragmatic and rational policy".
For your assertion however, I can only yell "NO". I can't emphasise that strongly enough. Just gives supremely high chance of poor opinions heavily biased by the over confidence effect.
This is probably controversial, so bear with me, while I try and explain as it'll probably take some space. I'll apologise for length and poor explanation before I even start!
Let's look at a different neurotransmitter a moment - dopamine. Amphetamines markedly affect dopamine receptors. If most people take recreational doses they'll be stimulated, motivated, and sociable. If I take it I get no effect on motivation, and chill out. I'll probably sit and binge watch TV, work or read a book for eight hours straight. I won't be bothered to be sociable as I'd be delighting in the chilled calm. You may not be surprised to learn I have ADHD.
I fought for years with doctors "knowing" drugs and how they act on the brain in trying to get diagnosed with ADHD. Took years to not be dismissed out of hand. I don't find most doctors any more aware than the general public much of the time. That's not a function of where I live - time hanging around the assorted ADHD forums that have come and gone show all countries have had similar issues and hundreds of people struggling to get a diagnosis or referral because of horribly poor doctor, psychiatric or specialist awareness. Often those doctors are responding as though the patient is a normal brain merely seeking recreational drugs (which of course happens too), but it's entirely opinion. It's not uncommon to get misdiagnosed something else, perhaps with lasting and damaging consequences. (You don't typically ever get "undiagnosed" of mental disorders).
For many only when learning the field extensively themselves is real progress made. It's quite sobering to realise just how many have had to start studying and reading research themselves prior to being able to get diagnosis.
Minds are more difficult as we tend not to be able to diagnose anything like as easily as a broken bone, germ or viral illness. There's a need to rely solely on self reporting as we can't, yet, throw someone in a scanner and identify them as having depression, ADHD, Asperger's or LSD addiction. In the case of recreational drugs and use there's going to be little in the way of studies of their effects on healthy minds. I seem to remember quite recently LSD had the first study in 50 years. Anti depressants often seem to have suicide and suicidal ideation as side effects - the same medicine can have dramatically different mental effects in ways not often seen with say paracetamol.
The main difference then is a doctor is more likely to be believed and have opinions acted upon without any real understanding. They may have better understanding, if and only if the correct studies are there. For the most part they won't be. Yet.
Doctors are well placed to advise on studies and contraints as health impacts arise from legalisation however.
There are several policy areas where doctors feel they have more to add than they actually do: tobacco discussion, whether or not bicycle helmets should be legally required, euthanasia/abortion issues (the moral aspects of it, not the technical ones), ...
I think it's a remnant from when doctors were part of the 'upper class' of the village (or even city), along with the priest, the school teacher, etc. Whereas today, in more educated circles at least in my observation, doctors are just body mechanics. They derive most of their status from their pay. (Much less so e.g. in the small town I'm from, where doctors are still respected just for being a doctor - but are paid less).
Edit to add: I'm not going to modify my comment above because that invalidates all the responses, but it seems like all responses are taking the wrong message from my post: I'm not making some sort of moral judgement on the work of doctors, what I'm saying is that doctors aren't any longer so special that they're part of the intellectual elite (and hence are consulted on topics being their expertise) just for being a doctor. Sure most doctors do work that's beneficial to many people, but so do teachers, and I don't think anyone is going to claim that teachers have high status in society (because of it, or at all).
> today, in more educated circles at least in my observation, doctors are just body mechanics. They derive most of their status from their pay.
...WTF? Is it even possible to write a more egotistical comment? Most doctors (especially surgeons, etc.), along with firefighters, police, etc. derive their respect in "educated circles" not from their pay (that's some of the worst nonsense I've heard this week) but from the kind of work that they do: saving other people's lives, especially in situations where one small mistake on their end can prove fatal for one or more parties involved. That's quite sufficient to deserve a ton of respect just by itself....
"Most doctors (especially surgeons, etc.), along with firefighters, police, etc. derive their respect in "educated circles" not from their pay (that's some of the worst nonsense I've heard this week) but from the kind of work that they do: saving other people's lives, esp"
Ah yes, the 'everybody deserves a medal' mentality. Let's not forget the garbage man, without whom we'd be choking on our own garbage! Praise his selfless sacrifice!
In the mean time here in the real world, those firefighters and policemen you talk about are (in the case of firemen) replaced with volunteers, and paid a very basic wage (yes yes because of political/union dynamics some of that group in some US states are paid well with early retirement yadda yadda yadda - I'm talking in general). Way to show status and respect, society!
In the mean time you're spinning a straw man of how I supposedly look down upon doctors, where my actual point is that doctors aren't that special intellectually speaking. Most people reading this could be doctors if they wanted to. Does that mean we look on them? No. But it does mean we don't put them on some pedestal as if they're so smart - which is what used to happen when the majority of people had no or very little education.
> one small mistake on their end can prove fatal for one or more parties involved
This right here is why I respect the hell out of doctors. Every morning, they wake up with the knowledge that today, they could kill someone through inattention or ignorance. I'm sure that they don't think about it that way while brushing their teeth or whatever, but that's an awesome responsibility.
Do you share the same respect for airline pilots, bus drivers, crane operators and all of the other occupations that can kill multiple people through inattention or ignorance?
I do respect those people, but the comparison to my profession is ludicrous.
Here's what happened just today at work for me:
Before noon, I received two patients in septic shock. Both required intubation and central lines. One required a chest tube. Early in the afternoon I had my finger directly compressing a carotid artery that was spraying across the room as my staff tried to call in the vascular surgeon. Around 1800 PM I got a rapid GI bleeder who died spilling blood out both ends. Because it happened within 24 hours of an admission, the medical examiner had to be involved. She was young. One other existing patient in the ICU died of septic shock around 2000. I stayed until well past midnight talking to families, putting out fires, dealing with loose ends and spending time with the floor residents to make sure they know how to handle events like this without having a breakdown (not that I've figured it out yet). I just got home and will have to go back in about 5 hours from now and face who-knows-what. My friend, a neurosurgeon, is still in the neuro-ICU at this hour (it's about 0100 local time). Oh and flu season is coming up; that's when shit really hits the fan.
I realize that isn't a typical day for most doctors (nor is it a routine day for me; but not a rare one either), but it is demeaning to suggest that the emotional impact of this kind of work or the relationships developed therein could be even remotely comparable to that of an airline pilot with his/her passengers.
Oh, and I don't get paid a dime extra for being there 18 hours and assuming a bunch of extra risk. If the patient who's neck bled all over after surgery at another hospital decides to sue, I'll get added to the lawsuit, even though we saved his life.
My point is not to demand "respect" or elevate myself above anyone else; I come from a pretty humble family and stayed that way for the most part. I simply don't think anybody has a comparable work environment, especially the emotional side, which is very hard to describe to other people.
As for the parent post: opioid prescribing is complicated and is going to get worse as our "performance" becomes tied to patient satisfaction surveys. Won't affect me much, but will be a very difficult balance for primary care doctors.
Paramedics/first responders save lives too, in scenes just as dramatic or more as yours. Is being a paramedic 'high status'? No it's not. Look I'm not here to tell you or anyone anything about how useful or stressful their jobs are; hell I mean I sit at a desk all day writimg code that'll be run by 10 people ever if I'm lucky. What I'm saying is that status doesn't depend on any of that, or on how hard you work, or on how hard you studied. I'm not making any claims about whether that's right or not either, just describing reality.
Or how about this - does your boss still do the things you describe? If your hospital is medium sized or bigger, he spends half his day pushing paper and the other half controlling petty infighting between the surgeons. Yet is his job lower status than yours? Would getting his job, for you, be a demotion or a promotion? Seems to me the answers are pretty obvious.
My hat goes off to you for working so hard and being so dedicated. It sounds like you had an awful day, and I'm sorry.
Please dont take this as criticism, because I respect everything you do. But consider this:
> I don't get paid a dime extra for being there 18 hours
Why do you have to be there for 18 hours ? What if medical school weren't so difficult to get into, that there were enough doctors for each of you to work 4 hour shifts ? You could then do 4 hours of intense-pressure, saving lives. An hour lunch break, return and do 4 hours of paperwork/damage control, etc. Then go home and relax like everyone else ?
For the amount of money those patients are being charged ($10k+ per night in ICU), there's adequate money going around to hire 5 more of you to allow 6 separate 4-hr shifts of trauma coverage.
I dont know where the bottleneck is. But I'm concerned that there's an artificial scarcity somewhere, perhaps in medical school. Perhaps in the board certification. Maybe there shouldn't be a 15-year educational requirement ? Maybe a nurse with 6 years' experience could be qualified for a "micro-practice" in a limited capacity ? No, not a PA (see, now we're dealing with status/prestige ), a doctor, responsible for pt's for 4 hours/day.
I dont know where the problem is, but maybe we are just over-regulated ? We put so much care into making sure the wrong people dont get in, that now we're overworking those who do get in. In that 18 hour shift you described, do you really think you are as alert at the end of the day as you were that morning ? Overworking people undoubtedly leads to lower quality, and a there has to be a breaking point where it's going to be better to let more people in than it is to burn out the few people who do make it past the barriers.
That's a lot of sepsis. How much of that was acquired during the stay in the hospital, one wonders?
How effective can you actually be pulling 18 hour days?
I appreciate that you feel like a hero, but everywhere else in the civilized professional world we've learned that keeping such hours and being in permanent firefighting mode leads to sloppiness and inefficiency.
Then again, when we're sloppy and inefficient, we don't kill anyone.
(I've worked on software for use in ICU and other clinical environments, and frankly am utterly unimpressed at the systems doctors and administrators allow to persist at the expense of patients so that they can either feel like heroes or retain talent.)
Ask someone who served in Iraq about his time there, it would make your day look like puppies and sunshine. Should we defer to jarheads on all matters of domestic policy?
Almost certainly an ulcer in the stomach or duodenum, especially given her medication use. If the ulcer erodes an artery, it can be catastrophic. Just not common to see it someone as young as she was. About 5-10% of "lower" GI bleeds are actually rapid upper GI bleeds. Easy to miss.
Hell, even software programmers can kill a lot of people by letting a bug slide. But I agree that in general, doctors have a bigger and more direct responsability in that matter.
There are a lot of doctors (and especially nurses!) that provide valuable care every day. That said, we can't just blindly assume they know what they're doing and give them respect that they haven't earned--especially when the healthcare system is as fucked as it is today and they refuse to take an active role in fixing it.
The status you speak of for physicians in general is derived from saving lives - generally thought to be pretty honorable. Also, doctors who work in more rural areas are trending towards making more than those in cities and already do make more when cost of living is accounted for.
Not going to say a dermatologist or podiatrist can't save lives, but I think they get most of the respect granted doctors who do without the same effect on society.
My pet peeve is the "cosmetic surgeon", making obscene amounts of money and wasting valuable medical resources to pursue a practice of enabling vanity.
I feel like this is a narrative for which I am nostalgic despite being too young to have ever really experienced even though I grew up in a small town. I wish that those in my community who serve their neighbors in an important way were more respected socially. Sure, the local paramedic - Sam - doesn't make a lot of money, but everyone knows he's a good guy you can rely on. Everything feels so transactional.
many paramedics work for a private company for peanuts.
Public figures are still respected. I suppose it's less so because education is more common. The Gulf between a medical doctor and your average citizen was huge
It completely depends on the type of doctor. If we're talking about GPs, then sure, their work is mostly standard and they refer anything non-standard to a specialist. But specialists are definitely held in very high regard in their social circle. Surgeons especially.
>>They derive most of their status from their pay.
No, they derive it from the insane amounts of education, training and hard work they have to put in to get to where they are at. It's basically "crunch time times two" all the time from the moment they start med school until they complete their residency, and only slightly lessens afterwards.
You know who also works hard? Juanita the single mom illegal immigrant who works one job in the chicken factory during the day and another cleaning motel rooms in the evening to feed her 4 children, and still barely scrapes by. How much status does she have?
I'm not dismissing how much doctors study, or how hard they work (outside of GP's and some specialties like dermatology). Many of my friends and family are doctors. While I agree that I might have phrased my comment a bit more carefully, it's awfully lazy to just conclude from what I said as 'doctors are only after the money'.
My real point was - being a doctor no longer (by itself) makes one an intellectual. Knowing quite a lot of doctors myself, I can tell from firsthand experience that many of them are just as (un)informed and (dumb|smart) as the, say, smartest 1/3th of the population. Doctors have lots of highly specialized knowledge, yes; that doesn't make them better on issues that go beyond medical technicalities than a mathematician or lawyer.
There are some doctors who look at their job as technicians for money.
However there are some who really do go out of their way and give a 100% at the loss of their own family. But, probably so do some politicians...
i agree with your point, that people's qualifications in one field don't necessary entitle them to a respect from authority in another field.
tbe reason they are asking for doctors help in this is, to reduce the political fallout from people who respond to authority. They may as well also ask for help from teachers, firefighters, priests, airplane pilots (I believe Air Force even uses methamphetamines) ...
you seem to be garnering a bunch of hostile responses, so I want to say I agree with you. And I think a lot of their "prestigious education" is somewhat "prestige theater". I believe it's artificial scarcity, either to keep the prestige high, or (somewhat cynically) to keep wages high.
Yes, there has to be a rigorous QA process to get your medical license and keep practicing. That's already covered by a state board of medical examiners. Where I think the artificial scarcity comes in is medical schools. There shouldn't be this "interview" process and excessive scrutiny, 6-figure tuitions, and do-or-die levels of pressure to simply learn how to practice medicine. I think this manufactures prestige.
There should be enough medical schools for virtually anyone who wants to get in. If idiots go they will flunk out at exam time. No need to screen them at the door. No need to ensure they have "straight-A's". What they need is the willingness to learn. It should be "to be a doctor, you need to learn topics {A,B,....Z}, and once you do, and demonstrate that to the board, you are a dr."
You should be able to start out emptying bedpans and have a ladder you can climb to get to physician. I can't think of someone who would make a better dr than one who has already worked 10 years in a hospital. Go from orderly/CNA, to nurse, to practitioner, to dr. And structure the education to work around this! Once you get to nurse, allow a 3 day-work, 2day school schedule. Even if it takes you 8 years, you have an MD with basically an entire clinical rotation completed. And (theoretically) no debt! Now this person doesn't need a $200k salary to pay back their tuition loans. Ultimately this could lower medical costs for everyone.
That may have been true in the past but the situation has rapidly changed over the last decade. Amphetamine and opioid abuse stemming from over-prescription is becoming far too common and doctors are now experiencing the full spectrum from people genuinely in pain to high-risk heroin addicts. When the latest public health scare is a drug abuse epidemic attributed to the medical system instead of the black market, it's far harder to ignore the futility of the war on drugs.
That's hellbanning for you. It's also a good reason to look at your user page via a private session in your browser every so often, esp if you have no comments to you.
So you're saying that doctors are only capable of evaluating personal experience, and not evidence collected by others? That puts a whole new spin on the medical profession.
It's even worse than this. Every panel of experts called to testify on this contains doctors from the treatment/prevention sector and that subgroup of doctors holds even harder on to this bias than a regular practitioner.
The thing is that doctors are hypocrites, they smoke, they drink, they eat junk food, they don't exercise, they do hard drugs and help themselves to unneeded prescriptions, they don't drink enough water, they don't sleep enough, etc.
They know what's best for people, but they also know that people can make informed decisions, they certainly do.
You think doctors don't experiment with drugs at university the way they do with alcohol?! At my university the medical students were renowned for their extra curricula "drug research".
Our laws on drugs are really quite arbitrary. In the UK people have factual evidence showing that drugs such as MDMA causes both less physiological and social harm than alcohol[0] so it's not really that we are trying to prevent harm rather than can't prohibit a behaviour that is now deeply ingrained in society.
Humans love intoxication. It's as old as time, with mountain people chewing coca leaves or brewing mescaline tea. Even in cultures where alcohol is banned such as the middle east, they simply found alternatives like coffee and tobacco.
Where do you even draw the line? Once you appreciate that everything is a "chemical" does binge-eating sugary foods count as intoxication? It's excessive by its definition and is harmful to the body and society. Should we start cracking down on "donut junkies"?
What about activities which release dopamine like gambling and videogames?
The treatment of the law on drugs is outdated and mainly political / social now more than it is actually in the interests of society. Don't take my word for it, here is an ex undercover policeman who turned his back on the fight against drugs[0] and HN discussion[1]
Any sort of rational approach would start with legalizing use, and possession in amounts that are clearly intended for personal consumption, of any drug, excepting those that have immediate effects that are highly likely to be harmful to those in the vicinity (e.g. drugs that consistently induce violent hallucinations).
We can discuss transfer, sale and other forms of distribution on a case by case basis, depending on how harmful the drug in question is. And we can say that possession of significant quantities, clearly beyond personal consumption, should be considered evidence of intent to distribute (although it should really be rebuttable - i.e. the person should get a chance to present counter-evidence to prove that there was no intent to distribute, and the judge or jury should decide on the balance of probabilities).
But there's no rational reason whatsoever to punish consumption of anything.
I'd wager a guess Trump snorted his share of blow in the 1980s, but congressional republicans and the private prison industry are going to be calling the shots on the drug war for the next 4 years.
Only at the federal level, which is a much smaller portion of the prisons in the us. From the first thing I found, there are more people simply sitting in a jail waiting for trial than there are in federal prisons [1].
Which is an issue considering the lobbying the businesses do [2] - they are very much invested in keeping their businesses going and keeping folks in jail.
We don't need doctors to point out that the War on Drugs is bound to perpetual failure. Don't even need a scholar. Anyone with two eyes wired to a working brain would reach the same conclusion. That being said, the more people speak up, the closer draws the day where we may transition drug policy into a saner state.
It's all rooted in good intentions, of course, as was the US ban on alcohol a century ago. But sometimes the road to mafias and murderous drug cartels is paved with good intentions. Time to wake up.
The alcohol and tobacco lobbyists will be dead set against the removal of prohibition. Although alcohol and other drugs tend to go together when binging, the amount of alcohol consumed will likely be less. Additionally a mild drug like Marijuana will likely be preferred by some people who would traditionally have a glass of wine or beer every day after work instead of a stronger and more dangerous drug like Alcohol.
That seems doubtful. The glass of wine or beer is, firstly, more palatable than marijuana, secondly, you can do it indoors without everything smelling like weed, and thirdly, the mild depressant effect of one alcoholic beverage is way more pleasant than getting high. Not to mention the cost.
I think for most people an entire joint by themselves is going to take care of them for the entire night (or longer if it's snuffed out and re-lit). How many beers or mixed drinks are you getting for $3.50?
Your comment is 100% opinion - I think it's very obvious that different people have different opinions. That is why I said "some people" not "all people".
Vaporisors and edibles are odorless, and the price would surely come down if it was grown in commercial quantities.
Private Prisons (through their lobbyists) are likely one of the main opposers of loosening the War on Drugs. We don't know clearly what they lobby for - they would never admit it publicly, but it is not hard to guess. Stopping the War on Drugs would be a cut to their profit margins.
Couldn't read the article, but I think the issue is that doctors aren't directly more qualified to call for drug policy reform than anyone else.
Hear me out: Doctors are aware of the side effects and dangers of drugs, and the harm they cause people who take enough drugs to require medical help.
However, a doctor isn't specifically informed about the cost of prison, the damage imprisoning someone does to their families, and their communities, and their prospects for rehabilitation.
Drug policy reform calls for a comparison of the impact of softening drug law against the social impact of imprisoning the people we enforce drug laws on.
There just isn't a profession with credible authority in that specific area. It's sort of like what a public policy think tank should make a recommendation based on. But I don't think any corporate interests align with the message enough to fund that sort of research/lobbying.
>>But the effectiveness of prohibition laws, colloquially known as the “war on drugs,” must be judged on outcomes. And too often the war on drugs plays out as a war on the millions of people who use drugs, and disproportionately on people who are poor or from ethnic minorities and on women.
>There just isn't a profession with credible authority in that specific area. It's sort of like what a public policy think tank should make a recommendation based on. But I don't think any corporate interests align with the message enough to fund that sort of research/lobbying.
You don't need a particular profession to label the war on drugs an abject failure. Just examine the results. The war on drugs has not made one dent in the demand or the supply. It has led to ever more potent drugs with lower prices and profits going to violent criminals. It's a joke
> The war on drugs has not made one dent in the demand or the supply.
While I am also opposed to the war on drugs, let's not make overbroad claims. There is evidence that alcohol prohibition actually reduced demand. Not 100%, but significantly. From Wikipedia:
> The Prohibition was effective in reducing per-capita consumption, and consumption remained lower for a quarter-century after Prohibition had been repealed.[34]
> Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. They rose after that, but generally did not reach the peaks recorded during the period 1900 to 1915. After Repeal, when tax data permit better-founded consumption estimates than we have for the Prohibition Era, per capita annual consumption stood at 1.2 US gallons (4.5 liters), less than half the level of the pre-Prohibition period.32
32. Miron Jeffrey A. and Jeffrey Zwiebel, “Alcohol Consumption During Prohibition,” American Economic Review 81 (1991): 242–247; Dills and Miron, “Alcohol Prohibition and Cirrhosis”; NIAAA, “Apparent per Capita Ethanol Consumption.” The figure is for 1935.
> There is evidence that alcohol prohibition actually reduced demand.
no. The decrease of consumption in US that you posted is pretty much similar to the decrease in consumption during the same time in England for example - from 1900s to 1920s-1930s the consumption decreased 2-3 times and similar to the US it stayed that low until 1960s :
The Prohibition had no noticeable effect on consumption. The 2 World Wars and state of economy between the wars were the major factors what affected the consumption.
Saying that Prohibition in US reduced consumption is just like saying that Giuliani's "broken windows" policing and "stop and frisk" caused decrease in crime in New York - it actually didn't as the decrease in crime in New York followed the same trajectory as in other cities where weren't such policies applied. Or like it is frequently said on HN - "correlation isn't necessary causation".
It's amazing that we just still live in a system where the people who methodically know nothing about something can end up controlling the majority share.
The war on drugs was never about health, but was about racism. One poster talked of Chasing the Scream which details this. So the idea that doctors should be advocates for the ending of the WoD just continues the false rationalisation that health is at the heart of the WoD. I can ask 1 question which will show that health has nothing to do with it: why is hemp illegal?
What is at the heart of ending the WoD is human rights; a topic which doctors have no more knowledge than anyone else.
This comment strikes me as an example of race reductionism that does more harm than good. The war on drugs unquestionably has a racist component and racism contributed to its origins, but it's not solely an issue of race and affects more than just minorities. Thinking of it being as "about racism" makes collaboration with natural allies more difficult.
In this case those natural allies include the white working class, which suffers greatly from drug addiction, as well as doctors and other health care workers who value the integrity of their profession and believe drug policy should be focused on improving outcomes for drug users.
Social action in America has fundamentally always been about compromise. Race, class and gender reductionism discourage it. It's both possible and productive to say you empathize with the problems someone else faces, your set of problems overlaps, and the two of you can cooperate without debating whose problems are more significant.
somebody noted recently that when crack epidemics was ravaging black neighborhoods it was considered an issue of crime and WoD was unleashed against those neighborhoods, when today heroin and prescription drugs abuse hit white suburbs - it is a public health issue.
I for one is happy that it is started to be treated as public health issue, it is a long overdue approach, yet one can't not to see the race based disparity mentioned above.
I'm sort of tired of not being able to point out that the white working class is racist. If they want to work with their 'natural allies', they should probably just get over their racism and do it.
Why physicians? Because the proletariat still have a little bit of say on policy in this country. If you ask citizens with strong anti-drug stances why they support tough drug laws, very few (if any) will say "because I hate minorities."
So we've got to change the minds of the voting base. Physicians are highly respected in this country and to have them come out en masse and state that drug addiction is a health issue and not a criminal issue would do a lot to change the minds of voters...which could then slightly change the minds of our lawmakers.
I think that the LEAP organisation will have more clout than physicians to end the WoD, and certainly more clout with the proletariat, as you say. Ex-law enforcement officers who have been in the trenches and understand exactly the societal damage caused by the WoD would be better advocates than doctors.
And your point about "doctors come out en masse and state that drug addiction is a health issue" may be a double-edged sword for them since we all know that the opiate epidemic and subsequent heroin use increase are issues created, by a large part, by doctors.
I do think you are correct about LEAP, but I don't believe a large percentage of the police force would ever condemn anti-drug laws. Don't bite that hand that feeds and all that.
I don't think physicians are primarily responsible for our heroin epidemic, in my opinion that prize belongs to the pharmaceutical industry and our politicians...but I'm open to any evidence that proves me wrong.
the structure of health care in the united states makes it really difficult for doctors to not escalate to opiates for pain management. doctors are evaluated on patient satisfaction not on patient outcomes which incentivizes them to skip straight to opiates when faced with a patient who complains of pain and is unsatisfied with tylenol
While the official war on drugs was started as a means of suppressing and discrediting blacks by the Nixon administration, the reason it won't end any time soon is that it has long been and continues to be both a revenue stream and a tool of political disruption for the CIA and DEA. (Not that this changes the fact that it still today results in the suppression of poor and minorities.)
The US doesn't "need" drug money to finance brutal dictators. It's currency is now backed by its military might. It can print as much as it wants and if you even think of trading OIL in another currency they invade and liberate your ass.
While it sounds good, it's pretty bullshit to say the war on drugs is about financing dictators.
It's fair to say that the CIA does have pet opium projects, with US ground troops playing guards for Afghan farmers. But that's a different thing.
>While it sounds good, it's pretty bullshit to say the war on drugs is about financing dictators.
You're missing the point. Drug sales can be monopolized by the powers that be to generate off-the-books revenue streams. This can then finance any questionable activity they'd prefer not to be held accountable for.
This exact scenario has happened before - see the Iran-Contra affair.
While it might have happened. It doesn't need to anymore. Seeing as how Billions of dollars can just up and disappear from the DoD's accounting books and noone has been held accountable.
Weren't bans on drugs pervasive throughout history?
Isn't it amazing that you think that? Seems to say something about the schools... If physicians can finally, at this late date, consider doing the right thing politically, it makes one wonder... will public schoolteachers ever kick the DARE officers out?
No, some controls were introduced at the end of the 19th century and prohibition (of non-alcohol drugs) really got going in the 1920s. Before that it was essentially a free-for-all.
True for Europe and America. Asia and the middle east have had religious bans that where legally backed up by theocratic governments or totalitarian rulers that would ban substances (mainly opium) on and off in their particular kingdoms.
We (the US) are in the middle of an opioid addiction epidemic. The surgeon general has just made this his highest priority - and physicians are now expected to take a soft stance on drug use? While I am all for reform - there seems to be a major disconnect here.
Firstly, the epidemic of opioid prescription and addiction is not as profound in all parts of the world. The BMJ is international but UK based and the authors of this piece seem to be British.
Secondly, how in the hell id the position "The war on drugs has failed, we need policies that promote harm reduction and ethics over failed punitive actions" taking a soft stance?
That's part of the whole reason we fail so hard and keep failing, that people have this weird idea that actually tackling the problem is 'soft' and presumably continuing to beat our collective heads against the wall, despite a continuing lack of it acheiving anything, is what? Tough? Hard?
I've published letters in The BMJ so I am familiar with the audience, which is worldwide - particularly the letters / editorials.
I don't disagree in any way that policy reform is badly needed and the war on drugs has failed: My point was more that the messaging seems to be very conflicted these days for physicians in the United State. To me - as a layman - there appears to be no "middle ground" for both policy reform and bringing the opioid addiction under wraps. That is the disparity I am trying to point out and what I find to be conflicting / frustrating.
I'm afraid I'm really not sure I see a conflict between "we need a new approach on drugs, the war has failed to reduce harm" and "we are causing harm with our prescription policies and should probably stop handing out hardcore opiates like candy"
Unless you are subject to the sort of black and white thinking that means any change in policy necessarily means a completely open market for all drugs, that is.
Many middle ways are possible - legalise and regulate access to less harmful drugs like cannabis (as is happening in much of the US), and offer maintenance and treatment to addicts of more harmful and addictive substances without criminalising them. Not a scenario that requires giving out oxys by the fistful.
There doesn't need to be a middle ground, because the logic of abandoning the war on drugs is that it actually lowers drug use more effectively by providing healthcare rather than punishment. This policy reform and lowering opiate addictions aren't at opposite to each other, the former would help the latter.
This pub is f/k/a the British Medical Journal. They're addressing a worldwide audience of physicians and health-care professionals. It seems a bit narrowminded to interpret their suggestions in a US-only context.
There's plenty of evidence supporting the position of this editorial. Various nations have tried some form of decriminalization. The effects have been generally positive in places like Portugal, Switzerland, and the Netherlands.
But, of course, if drug users are the face of sentient evil, then decriminalizing the drugs is the same as failing to resist evil. This is why selling the idea in the US is very difficult. We've been taught for generations that drug users are inherently evil, and treating them is, at best, a waste of time.
US physicians have enough trouble with the federal government as it is. The US government has a century-long history of making the professional lives of dissenting physicians very difficult indeed. It's unreasonable to expect many of them to embrace this cause with public speech.
Here in Massachusetts USA, the voters recently chose to end the prohibition on cannabis (following the lead of Colorado and Washington state). The Roman Catholic church (Boston diocese) chose to compel their clergy to speak against this initiative from their pulpits on the Sunday before election. (Huh! I thought electioneering from the pulpit was prohibited. I guess not for the RCs.) I know a couple of law-enforcement leaders who privately supported the end of prohibition, but didn't dare speak publicly.
The end of prohibition has to come from voters in the US. Physicians can't do it: the government can revoke their licenses. Legislatures can't do it; they're much too beholden to the military-industrial complex that fights the war on drugs. Religious leaders can't do it: to declare that certain behaviors aren't evil erodes their worldly authority, which comes mostly from the ability to condemn "those" people, whoever they are.
It's reassuring that policy can change due to voter interest in spite of the resistance of career politicians - it demonstrates that American democracy has yet to fail absolutely.
Perhaps the focus of people interested in new policies should be directed at state reform rather than federal? Ballot propositions seem to have been rather effective recently, and they encourage the education of constituents rather than the few legislators currently in power who may have conflicts of interest.
Then nationwide reform no longer has the excuse of "that wouldn't work in America!", and people impacted significantly at least have the option of moving to those states (i.e. MA and CA for gay marriage a few years ago).
Yes, for sure. Here in MA we did pioneer state support for marriage equality, and we also pioneered individual-mandate health insurance (now known as Obamacare).
HAHA! Doctors? they are the reason for the failure. Doctors were directly responsible for the overdose and death of my wife. The epidemic of drug abuse which starts by over the counter addiction is perpetuated by DOCTORS.
Citizens need to lead for calls of drug policy reform. We are the masters of our destiny, The problems surrounding drug abuse directly affect US, the people who live in our communities. Start going to your local city council meetings and take a stand, voice your opinion. This isnt going to be solved by Doctors! The majority of Doctors are direct beneficiaries to this abuse. I am not saying EVERY doctor is bad, I am saying that they are part of a business and drugs are a high margin product.
My cousin nearly lost her home and everything she had due to an opioid painkiller addiction -- from drugs she was prescribed by a doctor after major surgery. This has become a silent epidemic, and a gigantic one, and it's ruining lives more and more every day.
My condolences on your loss. I wish there were an easy way to put an end to this horrific and needless suffering, but I fear things will only get worse before they get any better.
This is weird reasoning, you don't wake up one morning and are suddenly addicted to opioids, all involuntary and without your doing. Becoming so addicted to the drug of your choice that you can't quit is a process, and it requires a conspicuous absence of introspection, if not conscious choice.
I'm saying this because I have seen close relatives turn into alcoholics. The mental illness/disease angle doesn't do the addiction dynamics justice, and you know that when you have seen other relatives develop genuine mental illness. There's a difference between drinking too much for several evenings in a row without a real reason and not getting worried about it the following morning and losing touch with reality due to developing schizophrenia.
There are living conditions that make it understandable why someone would like to choose not to be sober but leaving personal responsibility out of the picture, saying it's the doctors fault or it's all in your genes, is infantilizing.
If your cousin lost his home over an opioid addiction sustained over opioids prescribed after major surgery, where they are actually indicated the prescribing physician and the class of drugs are far down on the list of things to blame. At least in my world, they are.
There are psychological and social factors in addiction, and you can't just ignore these and solely hold physicians and pharmcos responsible for the opioid epidemic. The "addiction is a disease" model encourages this thinking - a drug addiction is acquired through contact with the abused drug and cured by detox, and it neglects to ask what factors predispose individuals to become victims of addiction. You can't forget that people live on Earth, which is a horrible place at times.
Ok, end the war on drugs. Force the ACLU and legislatures to enact laws allowing for forcing adults into mandatory detox and/or mental/rehab programs based on their drug use.
Live in a liberal area sometime and experience the excuses and lack of action around heroin addicts and meth heads and their criminal activities for the next fix or based off their current hit...
Live in a liberal area sometime and experience the excuses and lack of action around heroin addicts and meth heads and their criminal activities for the next fix or based off their current hit...
Don't those same problems exist in conservative areas too? I grew up in a small town in a pretty conservative state and I saw many more serious drug problems up close there than I ever see now in a mid-sized city in a very liberal state.
My point, didn't make it clear enough, if you point out issues like tracking needles (county exchange or pharmacy -- done through county ordering such), requesting enforcement of laws, etc. you end up being lectured that the city/county embraces best practices...
"Ok, end the war on drugs. Force the ACLU and legislatures to enact laws allowing for forcing adults into mandatory detox and/or mental/rehab programs based on their drug use."
Or, you know, actually look at facts instead of only the percentage of folks that have a major issue.
I'd not force a person to give up their daily evening pot habit any more than I'd force a person to give up their two-glass-a-day wine habit. I don't freaking care if a couple sends the kids away to the grandparents for a weekend so they can drop some acid. I don't care if someone does cocaine twice a year (Yes, I've met some folks like this).
Most concerning, however, is the US's general policy of using AA or NA as the standard program for detox or rehab. While it works for a few, it is really lacking in substance - even for folks that aren't actually addicted, merely get caught with some drugs during a traffic stop. Sure, it works for some folks, but I'd personally never be able to follow through due to my lack of belief in some "higher power" (in other words, god) nor do I believe that everyone is an addict for life.
I agree. I've met one single person that said it helped them: They replaced their alcoholism with tattoos and religion. Unfortunately it did nothing to help the lingering mental health issues he had, and he missed being more social.
There aren't any liberal areas in the US, at least with respect to the handling of people addicted to stuff on the narcotics schedules.
Switzerland (that notorious wussy liberal haven where every adult male is a member of the army) treats heroin and cocaine addiction by providing people with the substance, and helping them stop using it when ready. They save a lot on police and prisons.
That will never happen in the US. The police and prisons are far too big a part of the economy, and have too much influence over legislators, to allow them to be laid off.
Switzerland can get away with this. When DEA people from the US tell them, "recriminalize drugs or we'll cut off your foreign aid," they can say, "OK, it's a deal."
>Force the ACLU and legislatures to enact laws allowing for forcing adults into mandatory detox and/or mental/rehab programs based on their drug use.
I'm very uncomfortable with the notion of forcing someone to accept medical treatment without an extremely good reason. If we're going to entertain the notion, it should require a warrant to be obtained from a federal court.
Even the power to detain someone for psychiatric evaluation is used sparingly, and that has checks and balances to protect patients.
I guess you could say I enjoy recreational drugs and have done them all and my dad generally knows this and we've talked quite a bit about drugs, specifically the insane amount of opiates and benzos he used to prescribe to his cancer patients.
I've sort of gotten the impression the DEA was a hassle in his life and he would not want any attention gained by publicly saying anything but "drugs are bad" (aka the failed war on drugs). There would be no incentive for him to do this on a day to day basis; in fact, there would only be disincentives, at least in the short term.
One day in the early 00s, the DEA showed up at his practice unannounced and wanted to start auditing him on the spot. They told him he was in the top 10 opiate prescribers in his area and they were concerned. They had absolutely no paperwork, so my dad kicked them out of his office, and later the building via security. He told them to come back with a warrant. They never did.
What struck me about this story is how visibly upset he got at the idea of the DEA depriving people of comfort when they are in pain. When he told me this he said, very emotionally, "These people are dying and in pain and they want to look at paperwork?" I can only imagine how pissed off he was when it happened.
This anecdote is all to say I think that doctors probably take one look at any effort to delegitimize the war on drugs and say Nope. What's the point? To help society? Like they do every day as doctors? I just have never felt much of a "let's rock the boat" attitude from any doctors I've known personally regarding drug laws (keep in mind they live in a bubble where all of the drugs are available to them via an Rx pad -- this is very relevant to the enthusiasm drought IMO).
Based on a lifetime of being around doctors as personal and family friends (my mom is a medical doctor too), I don't think doctors are going to pick up this cause enthusiastically, even if it makes sense on paper.