It is popular, Rieder observes, to claim that we know what we, as a society, ought to do to solve America's opioid crisis--we simply don't want it badly enough. Those who focus on prescription opioids think we ought to stop prescribing so many powerful opioid painkillers. Public health professionals who focus on illicit drug use think we ought to expand addiction treatment and harm?reduction services. The problem, Rieder argues, is that the second claim is not obvious, and the first claim probably isn't even true. In short, the opioid crisis presents not only a problem of political will but also one of ethics. It will take work to discover or justify our normative claims in this arena. Rieder is a research scholar at the Johns Hopkins Berman Institute of Bioethics and the author of In Pain: A Bioethicist's Personal Struggle with Opioids.
Toward Fair and Humane Pain Policy
Daniel S. Goldberg
Pain policy is not drug policy. If society wants to improve the lives of people in pain and compress the terrible inequalities in its diagnosis and treatment, we have to tailor policy to the root causes driving our problems in treating pain humanely and equitably. In the United States, we do not. Instead, we conflate drug policy with pain policy, relying on arguably magical thinking for the conclusion that by addressing the drug overdose crisis, we are simultaneously addressing the pain crisis. This is a category error, decades of commitment to which have resulted mostly in a worsening of both public health problems. Disentangling our problems in treating pain fairly and equitably from our problems with drugs and substance use is the only path to humane and ethical policy for each. Goldberg is an associate professor in the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.
The landscape of addiction is dominated by two rival models: a moral model in which addition is partly a matter of choice and a model that characterizes addiction as a neurobiological disease of compulsion, not personal choice. Against both, Pickard offers a scientifically and clinically informed alternative. To help someone overcome addiction, you need to understand and address why they persist in using drugs despite negative consequences. If they are not compelled, then the explanation must advert to the value of drugs for them as an individual. What blocks us from acknowledging this reality is not science but fear: that it will ignite moralism about drugs and condemnation of drug users. The solution is to fight moralism directly. Pickard is a professor of philosophy at Johns Hopkins University.
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