My doctor and I have been working on the best way to handle my acid reflux. Antacids work but some are better than others. The one that I have had the most success with can also damage the liver. Our discussion turned to what do I do if the new antacid fails to work. He said then I would have to make a decision – is the toxic antacid worth continuing for relieving the symptoms of my acid reflux or should I take the less effective and less toxic antacid and learn to live with acid reflux which also carries the possibility of esophageal cancer. What is the better choice then — liver problems or esophageal cancer.

As I get older, I’ve been noticing that a lot of my healthcare decisions are like that — the choice isn’t an obvious good versus an obvious bad. It is two imperfect choices where I have to sort through the information and weigh the good and the bad to come up with an answer for me. Which got me thinking of chronic pain and addiction. There is this default preference for living with the pain over becoming an addict.

But why, particularly if the choice is being unable to have a normal life because the pain is too great versus living with addiction and having a normal life. The important question here is what makes the person more functional. Can they enjoy their lives with the pain or is it better lived with the addiction? There is something in the American Mind which fights the idea of addiction. Addiction is bad. Addicts ruin their lives and the lives of their families. At all cost, we must avoid addiction.

But can addiction be better than the alternate.? And, importantly, can addicts lead normal lives while addicted to drugs? Surprisingly, at least to me, most addicts lead pretty normal lives. They hold jobs and they take care of families. Now I am not saying it is ideal because it isn’t. It would be better not to be addicted to drugs. Life long drug use is associated with younger death — somewhat like the experience of cigarette smokers which is an addiction that is tolerated and we get along just fine. The problem with addiction is when the addict’s drug of choice is illegal or regulated by people who want to discourage addiction (think Oxycodone). Then the addict has to deal with dangerous suppliers, unregulated doses of their drug and getting arrested. These would all go away if we just let them use it legally.

And, yes, there will be deaths but would there be more than there are now. Certainly we would have reduction in deaths to turf wars between drug lords and wrong doses. It also opens up the possibility of working with addicts to get them off drugs whenever possible. Think again about cigarettes. An aggressive anti-smoking campaign has been successful in cutting the number of smokers dramatically. All while cigarettes were legally available and easily accessible.

I know several people that have chronic pain. They are in their 70’s. Their doctors try to find a way to stop the pain without addictive pain killers. The pain is still there which leads to the question what is worse chronic pain or drug addiction. And is getting off of drugs made more difficult by the return of pain? What is the point of 70 years not getting addicted to drugs? I know very few people in this age bracket that isn’t already taking a life long drug.

Personally, I have 4 prescriptions that I will take for the rest of my life. One of these is anti-depressant which if I stop, I will have problems. I am sure I can deal with them but it would be a difficult week or two and, if I do quit, would my depression return. So am I an addict and, if the addictive drug, allows me to be lead a normal life, why would I quit. If an addictive pain killer can do this, and everything else has been tried, why keep people from an effective, but addictive, pain killer.

This is a valid choice between options. I could live in pain and be addiction free or can live in pain with a dependance on drugs to keep me that way. I suspect this is already happening in the wink, wink nudge, nudge world we live in it. Doctors and patients are already making this decision but if Medicare and the insurance companies decide to monitor this more stringently, this wink wink nudge nudge deal can end tomorrow. Why not just come clean and say sometimes drug addiction is the best option in some cases.