The Dog that Didn’t Bark

PICK YER POISON: Among my demographic cohort ​— ​middle-aged Dagwoods facing various and sundry midlife demons ​— ​heroin, I understand, has become the hip and edgy thing to do. It’s nowhere as pathetic, I guess, as buying a red Miata convertible, less trite, perhaps, than parachuting out of a plane. But even so, shooting up has never climbed the charts of my personal to-do list. I got a thing, it turns out, about toilet seats. As in I’d prefer never to be found dead on one ​— ​like the great actor Philip Seymour Hoffman just was ​— ​with pants half-mast around ankles and a spike flopping in my arm.

My body may die, but vanity is eternal.

Not all heroin aficionados OD. But all spend an inordinate amount of their life perched atop the porcelain bowl, ingloriously fighting a losing battle against constipation. Not so sexy. Opiates wreak havoc upon the natural digestive processes, and junkies frequently find themselves desperately backed up far worse than Highway 101 on a hot summer Sunday afternoon. Caretakers for those few Beat poets surviving into their twilight years ​— ​perhaps the most culturally glamorous junkies who ever lived ​— ​have found, to their crushing disappointment, that 88 percent of the conversation revolved around obstructed bowels. Not so fascinating.

Hoffman’s death reminds us that the human impulse toward transcendent self-obliteration is well nigh universal, second only to the urge to suck. Some sublimate this craving with religion, eating locusts, or running 100-mile races through scorching hot deserts. For the rest of us, CVS and Big Pharma have increasingly filled the void, providing us highly addictive mood-altering medications that at least superficially appear to treat medically recognized maladies. These ​— ​if you are very lucky ​— ​are covered by insurance. Such drugs, it should be acknowledged, do meet a legitimate need for those struggling with chronic pain. Still, I find it striking that until pharmaceutical companies lobbied Congress to allow them to advertise their wares on television, America had steadfastly refused to even acknowledge the existence of pain. Up ’til then, it was just something to be inhaled swiftly and suddenly.

Given America’s expensive addiction to drugs is exceeded only by its much more expensive addiction to prisons, the fine line between legal and illegal habits is often impossible to discern by the naked eye. To date, the best determinant seems to be the color of the users’ skin, though I know in our post-racist society, this simply could not be possible. Likewise, I am often struck by the disproportionality of the response to the actual threat posed. For example, why did the State Medical Board adopt a scorched-earth policy 10 years ago, demanding that a local doctor ​— ​David Bearman ​— ​turn over his patient files in violation of patient-confidentiality rules because Bearman prescribed marijuana for a patient with migraines and a myriad of mood disorders in accordance with state law? Eventually Bearman would prevail, but not before the state board enlisted the state Attorney General to its cause and together sought fines of $1,000 for every day Bearman resisted their subpoenas. That’s scary business. As pot docs go, Bearman is thorough, conscientious, and expensive, a far cry from the fly-by-nighters who issue $99 recommendations for 60-second consultations dispensed in hotel rooms rented by the hour. Obviously, pot has its problems, and some are serious. But of the 325 overdose cases seen by Cottage Hospital ER docs in the past two years, not one was for marijuana ingestion. Contrast this with the studious inaction taken by the State Medical Board in the face of repeated warnings by emergency room doctors that Dr. Julio Diaz, the notorious Candy Man, was placing his clients at risk by overprescribing pain killers at a profligate rate out of his Milpas Street offices. At least 11 of Diaz’s patients died of overdoses; hundreds wound up in the ER. Only eventually would the state board strip Diaz of his license, and then after the Drug Enforcement Administration had gotten involved. Diaz, for the record, will be sentenced to 200 years ​— ​and a $10 million fine ​— ​this June. Although he was never charged with murder, Diaz “agreed” to plead guilty to 11 other charges, one ​— ​it just so happens ​— ​for each overdose. Freud, I guess, was wrong; coincidences do happen.

Last year, State Senator Hannah-Beth Jackson took what I thought was a tepidly indirect stab at the problem. She introduced a bill that would require pharmaceutical companies to take responsibility for collecting all the unused medications throughout the state and to ensure they were disposed of safely. This was to prevent “Skittle parties” in which young idiots joyfully swallow the combined contents of any medicine cabinets they happen to pilfer. It was also to prevent California’s coastal frog populations from being rendered hermaphrodites because of all the hormone-altering medications flushed down the toilet. Turns out the bill was more audacious than I thought. Big Pharma came unglued. It was unfair ​— ​unconstitutional even ​— ​they argued. And it would cost money. No doubt. Given that the pharmaceutical industry spent more than $100 million in California on political campaigns and lobbying in the first decade of the new millennium, clearly it can afford to do so. Otherwise, county governments ​— ​which organize turn-in-your-expired-pill pick-up days ​— ​get stuck with the tab. Jackson’s bill got assigned to the Environmental Quality Committee, where Big Pharma’s henchmen made sure it stayed. Their lobbying, I have been told, was “intense.” Not only did it not get out of committee, it never even got to a vote. Jackson has vowed to try again. Maybe she’ll get further. After all, it wasn’t unconstitutional for the state legislature to impose such requirements on companies making mattresses, batteries, tires, paint, and needles.

In the meantime, I guess I’ll just have to jump out of a plane. I’ll be driving a red Miata convertible when I do. Sure, it will be pathetic. But at least I won’t be constipated.