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Patient Z

the injustice of pain management in America


Access to pain medication is a human right

Many basic necessities have been discussed in the context of human rights. Access to clean water or even access to internet are two recent areas that have been discussed. Water is clearly more essential than internet, but both are so much a part of life today that societies around the world are recognizing the universal access to is more than just beneficial to society. Access is essential for survival. In this context, the situation of people in pain has received far less attention. Pain medication is essential for people who have a certain level of pain. Without it they will end their own lives or simply retreat from the world and survive based on the kindness of others.

Pain medication can be abused. But so too can people abuse the internet or deny water for their own profit. The difference is in the nature of the abuse. There is no substance we know of that has so vastly different effects in different people than morphine and its derivatives and surrogates, the opioids. The central point is that pain patients should not be made to suffer for mistakes made by others. Doctor's overprescribing, opioid manufacturers marketing and illegal drug use are distinct problems that are not a pain patient's fault. Pain patients urgently need medication to prevent pain, which can be intolerable. To withhold medication because of a regulation designed to address other problems is unethical and violates patient's human rights.

Meet Patient Z

A tale of two patients

Prescribing opioids must follow a careful and well-planned procedure. These powerful pain killers should not be used routinely for minor pain. Today there are weaker types of opioids, such as tramadol, that can be used for intermediate pain. There is an internationally recognized three-step guideline. The guideline defines three levels of painkillers that should be tried sequentially to treat a patient. These levels are:

1. Acetaminophen (also known as Paracetamol)

2. Tramadol

3. Morphine and related opioids

However, that guideline has been largely ignored in the United States.

The modern pain clinic in America

Pain is the antidote for morphine