The prospect of unfettered access to pain relief excites our deep-seated fear that to allow more doctors to prescribe more medications, we run the risk of getting more people addicted to prescription drugs. Since many families have suffered because one or more of their loved ones have found themselves "lost" in medications or alcohol, instead of happily engaged in more productive and wholesome pursuits, it is important to reflect upon what choosing pain care will mean for our society.

What we must come to understand as a society, if we want available pain care for the seriously ill, is that this decision requires us to hold ourselves and our family members, rather than doctors or substances, individually responsible for our destructive actions. We will have to stop relying on the convenient and ever-present excuse of drug or alcohol addiction that we routinely use to absolve ourselves of personal responsibility.

We will also be forced to forego the notion that jail or any kind of police coercion is a helpful and necessary addition to the treatment of addiction. As a disease state, it is properly treated by physicians, not the penal system.

I say all of this because it is impossible to provide pain care to people who need it, as long as doctors go to jail for mistakenly giving pain medication to addicts. It simply will not happen. Because a doctor cannot tell the difference, and, as recent developments have shown, the law enforcement community can't either, we will have to abandon our punitive approach to addiction, and will instead be forced to decriminalize and re-medicalize the diagnosis of addiction. That is, if we want pain care for the sick and dying.

We will also have to insist that our community members be responsible to themselves and to their family members for the (sometimes sorry) state they find their lives in. And we, as a newly responsible society, will need to provide support and medical care to those unfortunate members of our community who find themselves more interested in drugs (legal or not), than they are in their friends, families or work.

As it stands, we are allowing our punitive approach to addiction to determine the future course of our country, which, if we were thinking rationally and responsibly about this problem, we would chose to take another way. We now have a prison population of more than two million people, more than any other country in the world. Our proud Federal court system, once a bastion of due process, renowned throughout the world, is engaging in little more than show justice. Racial tensions are growing ever more pronounced. Street drugs are in plentiful supply and increasingly potent. We have created and perpetuated a criminal underworld that subverts democracy and security everywhere. And we are unable to care for our sick and dying because we have fixated obsessively upon punishing addicts and controlling access, rather than treating addiction seriously and responsibly, and likewise living up to our fundamental civil obligation to treat our sick and dying with as much sobriety and tenderness as we can muster.

We flatter ourselves as Americans when we think that by being harsh and obsessive, we are acting responsibly. We need to look at the results of our actions to accurately judge the quality of our remedies. We musn't reflexively reject the sane and obvious solution, in order to pronounce ourselves beyond reproach.

When we hold ourselves responsible for our destructive behavior, we open up the possibility for growth, for advancement- for the person "lost" in the medicine or the alcohol -to begin to wake up to his or her life's possibilities.

Life is a great gift, a gift that is properly cherished and lived to the fullest, with meaning and purpose. One hopes to always move toward a greater and deeper understanding of its complexities, its mysteries, and the suffering of others. Our situation requires us to have more faith in life's intrinsic draw, to trust that people want to live.

Those people, for whom life in a drug or alcohol haze is truly preferable to all of life's possibilities, those people live in an unspeakable hell on earth. We do not bring anyone to any better place by compounding their misery. Nor do we solve anything by withholding needed pain care from the sick and the dying.

We need to come together as people who are trying to get by, as best we can, and to love and honor each other along the way.

Siobhan Reynolds
Pain Relief Network