Lawmakers and individuals in this country are grappling with two emotionally charged issues, which on the surface, seem to be quite different, but are actually far more similar than they appear.
Both issues involve governmental regulation as it impacts human suffering. And a protocol that is already in place, albeit imperfect Oregon's Right-to-Die law could serve as a model for mitigating the damage caused by new restrictions on obtaining narcotic pain relief medicines, which are intended to address opioid addiction, but also cause needless suffering for people with legitimate need for these powerful drugs.
Instead of "Right to Die," let's call this idea "Right to High." The essence of the two is actually quite similar.
Of the many inadequacies in the American medical system, two are especially galling to me, becuase they are cruel, barbaric and they affect people who are least able to fend for themselves. Both involve considerable suffering.
- I have never been given an adequate explanation of why a parent or other loved one must suffer while dying in a way that you would never even consider for your pet.
- By any measure, this country is in the grip of a narcotic addiction problem that not only shows no signs of abating, but is actually getting worse. I have not heard of even one good strategy to combat this mess, but I have seen (and written frequently about) one very bad strategy making it more difficult for everyone across the board to obtain opioid narcotics. This has not only resulted in more human suffering for people who require strong pain medicine, but paradoxically may have made the addiction side of the equation even worse.
Although (in my opinion) still overly restrictive, the state of Oregon must be given credit for courageously tackling the very emotional and divisive topic the right to die.
The state's Death with Dignity Act makes it legal for physicians to assist with suicides, but does so with many restrictions. A patient who is requesting physician-assisted suicide must be:
- Age 18 or older
- An Oregon resident
- Capable of making and communicating health care decisions
- Diagnosed with a terminal illness (incurable and irreversible) that will lead to death within six months
To obtain a prescription for a lethal drug:
- The patient must make two oral requests to his physician, separated by at least 15 days
- He/she must also provide a written request to his physician witnessed by two people
- The prescribing physician, and a consulting physician, must confirm the diagnosis and prognosis
- The prescribing physician, and a consulting physician, must determine whether the patient is capable of making this decision
- If there is disagreement, e.g., either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination
- The prescribing physician must inform the patient of feasible alternatives to assisted suicide, including comfort care, hospice care and pain control
- The prescribing physician must request, but may not require, the patient to notify his next-of-kin of the prescription request
There are additional requirements for physicians.
These restrictions, in addition to the "speed" at which government typically moves can all but guarantee one thing: Needless, inhumane end-of-life suffering.
Two years ago, more suffering was inflicted upon certain people courtesy of the DEA. In a futile attempt to continue its (losing) so-called War on Drugs, the agency took action, but it was stupid action, as I wrote in a 2103 op-ed in The New York Post. The agency changed the way that Vicodin (hydrocodone plus acetaminophen) was regulated. Vicodin, which is not as strong as Percocet (oxycodone plus acetaminophen) had been classified as a Schedule III drug by the DEA. But, it was reclassified as Schedule II the same as Percocet and this made the drug much harder to get.
Schedule II rules include:
- Doctors cannot call or fax prescriptions for Vicodin to the pharmacy
- Patients must physically obtain the prescription; for someone with terminal cancer, or a crippling neurodegenerative disease, this could mean be driving for hours, especially in rural areas
- The maximum-allowed supply is three months
- Refills are not permitted
To impose these hardships on people who are already suffering mightily is just as cruel and inhumane as making terminally ill (and also suffering) patients jump through a long list of hoops to simply end his or her life the most personal of all decisions in a manner that they choose.
Worse still, and also ironically, it can be argued that clamping down opioid narcotics, not only didn't help addicts, but actually harmed them.
There can be no better example of this "backfire" than what happened in 2010, when after years of research, Purdue Pharma, the makers of OxyContin, finally discovered a formulation that made their product a high dose (40 mg) of pure oxycodone highly abuse-resistant. It worked. Or, did it?
Addicts stopped using OxyContin, and instead, turned in droves to heroin. Heroin overdoses have skyrocketed since, and there have been outbreaks of HIV and hepatitis C, because both of these are transmitted through needle sharing a common practice among heroin users.
So, in reclassifying Vicodin, the DEA managed to fail in two ways: Addicts were harmed, as were patients with legitimate needs.
The "Right to High" could allow patients who suffer from chronic, severe pain to obtain the medicines they need to simply make their lives bearable, which also containing a mechanism that would (presumably) limit the ability of addicts or potential addicts to get their hands on opioid narcotics. Oregon's law provides a logical framework for doing just this.
Here's how: If a patient is deemed to be suffering from a terminal, painful disease, or chronic condition that resulted in unrelenting, severe pain, he or she could be certified as such and be able to obtain narcotics in a manner similar to how Vicodin was dispensed when it was still a schedule III drug. Certification could be granted by two or more physicians as is the case in Oregon.
The benefits to such a process are obvious. Rather than make someone who is ill or incapacitated travel to physically pick up a prescription, their doctors could then be allowed to call or fax in prescriptions. Rather than a single three-month supply, allowing them three refills would reduce the necessity of seeing a physician from four trips per year to one. The lifting of this burden from truly needy patients would be humane and helpful.
The right to die, and the "right to high," although imperfect, both address unacceptable human suffering.
Common sense. Compassion. Dignity.
Can our government provide us with any of these?
Josh Bloom
Director of Chemical and Pharmaceutical Science
Dr. Josh Bloom, the Director of Chemical and Pharmaceutical Science, comes from the world of drug discovery, where he did research for more than 20 years. He holds a Ph.D. in chemistry.
