On Opium by Carlyn Zwarenstein

Author:Carlyn Zwarenstein
Language: eng
Format: epub
ISBN: 9781773101828
Publisher: Goose Lane Editions
Published: 2021-08-16T00:00:00+00:00

Simply by virtue of their income — even in Canada, where it’s low relative to the private sector, or in one specialty relative to another, and even, in most cases, despite the burden of student loans — physicians’ earnings and social status put them on a different planet from so many of their patients in terms of their day-to-day experience. By that measure, it would be best if most doctors (like most policy-makers) were not charged with the well-being of their patients who are poor, or in pain, or dependent on or addicted to opioids. That’s because keeping these patients well and, in fact, keeping them alive really requires that physicians understand that the patients’ self-identified needs drive health outcomes. Too often, due to their simple inability to predict or understand the material conditions of patients’ lives, they effectively, if often unintentionally, treat these patients as outcasts undeserving of either compassion or a deciding role in their own lives.

The discrepancy between official leadership and genuinely representative leaders is true also of chronic pain patients. Low-wage workers with physically arduous jobs make up a substantial proportion of people who have chronic pain, but may not have the childcare, transportation, or leisure time required to take in-person pain education classes or attend support groups or the financial resources to pay for massages, home help, prepared meals, or other things that can make a practical difference to someone living with daily pain, nor to join volunteer boards, act as patient representatives, or otherwise advocate for the interests of the poor majority with pain and for the policies that best serve their interests.

This is all bigger than opioids, though. A minority of people in the world make the decisions and control the resources that determine the lives of the vast majority. Their relentless pursuit of profit has decimated the Earth, unleashed disease and Biblical weather events, ransacked entire peoples and regions for the natural resources that have built and consolidated this minority wealth, and then provided loans to these regions on the condition they butcher social programs and buy the products and services and weapons of these same creditors. Physical pain — from literally back-breaking work at inhuman hours for unlivable pay, from injuries untended and diseases untreated, from histories of discrimination and childhoods of violence and neglect — results from these fundamental drivers of every social condition in our lives. And so does emotional pain. It sounds wild-eyed and radical to blame capitalism, colonialism, and systemic racism or white supremacy for the need for opioids as well as for the raging illicit market and overdose deaths. It is radical at least, in the sense that it goes to the real root of the problem.

We need to somehow convince the relatively very small number of largely white, wealthy, abled, solipsistic, and male decision-makers in the world to effortlessly understand and care about the rest of us, to actively want to diminish our pain. Or we need to upend the current structures of power.

Politics have

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