Pain, Pills & Will
There are many ways to die, but the public concern tends to focus on whatever is illuminated in the media spotlight. 2012 saw considerable focus on guns and some modest attention on a somewhat unexpected and perhaps ironic killer, namely pain medication. In the United States, about 20,000 people die each year (about one every 19 minutes) due to pain medication. This typically occurs from what is called “stacking”: a person will take multiple pain medications and sometimes add alcohol to the mix resulting in death. While some people might elect to use this as a method of suicide, most of the deaths appear to be accidental—that is, the person had no intention of ending his life.
The number of deaths is so high in part because of the volume of painkillers being consumed in the United States. Americans consume 80% of the world’s painkillers and the consumption jumped 600% from 1997 to 2007. Of course, one rather important matter is the reasons why there is such an excessive consumption of pain pills.
One reason is that doctors have been complicit in the increased use of pain medications. While there have been some efforts to cut back on prescribing pain medication, medical professionals were generally willing to write prescriptions for pain medication even in cases when such medicine was not medically necessary. This is similar to the over-prescribing of antibiotics that has come back to haunt us with drug resistant strains of bacteria. In some cases doctors no doubt simply prescribed the drugs to appease patients. In other cases profit was perhaps a motive. Fortunately, there have been serious efforts to address this matter in the medical community.
A second reason is that pharmaceutical companies did a good job selling their pain medications and encouraged doctors to prescribe them and patients to use them. While the industry had no intention of killing its customers, the pushing of pain medication has had that effect.
Of course, the doctors and pharmaceutical companies do not bear the main blame. While the companies supplied the product and the doctors provided the prescriptions, the patients had to want the drugs and use the drugs in order for this problem to reach the level of an epidemic.
The main causal factor would seem to be that the American attitude towards pain changed and resulted in the above mentioned 600% increase in the consumption of pain killers. In the past, Americans seemed more willing to tolerate pain and less willing to use heavy duty pain medications to treat relatively minor pains. These attitudes changed and now Americans are generally less willing to tolerate pain and more willing to turn to prescription pain killers. I regard this as a moral failing on the part of Americans.
As an athlete, I am no stranger to pain. I have suffered the usual assortment of injuries that go along with being a competitive runner and a martial artist. I also received some advanced education in pain when a fall tore my quadriceps tendon. As might be imagined, I have received numerous prescriptions for pain medication. However, I have used pain medications incredibly sparingly and if I do get a prescription filled, I usually end up properly disposing of the vast majority of the medication. I do admit that I did make use of pain medication when recovering from my tendon tear—the surgery involved a seven inch incision in my leg that cut down until the tendon was exposed. The doctor had to retrieve the tendon, drill holes through my knee cap to re-attach the tendon and then close the incision. As might be imagined, this was a source of considerable pain. However, I only used the pain medicine when I needed to sleep at night—I found that the pain tended to keep me awake at first. Some people did ask me if I had any problem resisting the lure of the pain medication (and a few people, jokingly I hope, asked for my extras). I had no trouble at all. Naturally, given that so many people are abusing pain medication, I did wonder about the differences between myself and my fellows who are hooked on pain medication—sometimes to the point of death.
A key part of the explanation is my system of values. When I was a kid, I was rather weak in regards to pain. I infer this is true of most people. However, my father and others endeavored to teach me that a boy should be tough in the face of pain. When I started running, I learned a lot about pain (I first started running in basketball shoes and got huge, bleeding blisters). My main lesson was that an athlete did not let pain defeat him and certainly did not let down the team just because something hurt. When I started martial arts, I learned a lot more about pain and how to endure it. This training instilled me with the belief that one should endure pain and that to give in to it would be dishonorable and wrong. This also includes the idea that the use of painkillers is undesirable. This was balanced by the accompanying belief, namely that a person should not needlessly injure his body. As might be suspected, I learned to distinguish between mere pain and actual damage occurring to my body.
Of course, the above just explains why I believe what I do—it does not serve to provide a moral argument for enduring pain and resisting the abuse of pain medication. What is wanted are reasons to think that my view is morally commendable and that the alternative is to be condemned. Not surprisingly, I will turn to Aristotle here.
Following Aristotle, one becomes better able to endure pain by habituation. In my case, running and martial arts built my tolerance for pain, allowing me to handle the pain ever more effectively, both mentally and physically. Because of this, when I fell from my roof and tore my quadriceps tendon, I was able to drive myself to the doctor—I had one working leg, which is all I needed. This ability to endure pain also serves me well in lesser situations, such as racing, enduring committee meetings and grading papers.
This, of course, provides a practical reason to learn to endure pain—a person is much more capable of facing problems involving pain when she is properly trained in the matter. Someone who lacks this training and ability will be at a disadvantage when facing situations involving pain and this could prove harmful or even fatal. Naturally, a person who relies on pain medication to deal with pain will not be training themselves to endure. Rather, she will be training herself to give in to pain and become dependent on medication that will become increasingly ineffective. In fact, some people end up becoming even more sensitive to pain because of their pain medication.
From a moral standpoint, a person who does not learn to endure pain properly and instead turns unnecessarily to pain medication is doing harm to himself and this can even lead to an untimely death. Naturally, as Aristotle would argue, there is also an excess when it comes to dealing with pain: a person who forces herself to endure pain beyond her limits or when doing so causes actually damage is not acting wisely or virtuously, but self-destructively. This can be used in a utilitarian argument to establish the wrongness of relying on pain medication unnecessarily as well as the wrongness of enduring pain stupidly. Obviously, it can also be used in the context of virtue theory: a person who turns to medication too quickly is defective in terms of deficiency; one who harms herself by suffering beyond the point of reason is defective in terms of excess.
Currently, Americans are, in general, suffering from a moral deficiency in regards to the matter of pain tolerance and it is killing us at an alarming rate. As might be suspected, there have been attempts to address the matter through laws and regulations regarding pain medication prescriptions. This supplies people with a will surrogate—if a person cannot get pain medication, then she will have to endure the pain. Of course, people are rather adept at getting drugs illegally and hence such laws and regulations are of limited effectiveness.
What is also needed is a change in values. As noted above, Americans are generally less willing to tolerate even minor pains and are generally willing to turn towards powerful pain medication. Since this was not always the case, it seems clear that this could be changed via proper training and values. What people need is, as discussed in an earlier essay, training of the will to endure pain that should be endured and resist the easy fix of medication.
In closing, I am obligated to add that there are cases in which the use of pain medication is legitimate. After all, the body and will are not limitless in their capacities and there are times when pain should be killed rather than endured. Obvious cases include severe injuries and illnesses. The challenge then, is sorting out what pain should be endured and what should not. Since I am a crazy runner, I tend to err on the side of enduring pain—sometimes foolishly so. As such, I would probably not be the best person to address this matter.