Narcoterrorism: Defining the Problem, Process, and Needs for Policy

September 11, 2010
Bill Schu

Giordano highlights issues in pain medicine that leave patient populations vulnerable.

A system is only as strong as its weakest link. In the context of pain medicine and the nation as a whole, our society is only as strong as our weakest, neglected, and forgotten pain patient. That's why the key to preventing narcoterrorism is making changes to the policies that dictate pain medicine to allow for better physician-patient interaction, trust, and dialogue, said James J. Giordano, PhD.

Giordano’s presentation, “Defining the Problem, Process, and Needs for Policy,” examined current laws and policies that dictate pain medicine, and analyzed the effects on pain patients and society in the form of narcoterrorism.

Giordano is the director of the Center for Neurotechnology Studies, and the chair of academic programs, at the Potomac Institute for Policy Studies. The word "terrorism" is used to describe a situation where patterns are created to train individuals to adopt actions that are uncommon to their own culture, he told the crowd. Terrorism involves small groups of agents and participants seeking to affect the nature and behavior of larger groups, leaving these groups vulnerable.

There are three forms of manipulation that take place in the process: attitudinal manipulation, economic manipulation, and practical manipulation (including acts of fear). Narcoterrorism occurs partly because of the apparent discrepancies brought on by the "War on Pain" and the "War on Drugs" campaigns, Giordano said. Although the field of pain medicine addresses the very real issue of pain in the country, the complications associated with prescribing opioids - mainly in the worry of misuse and abuse - plays a role in dictating the therapeutic freedom of physicians and the rights of patients.

The problem involves a biopsychosocial model, according to Giordano—it targets both biological and psychological vulnerabilities. Those involved in medical care and those creating guidelines need to be aware of the threats inherent in narcoterrorism and be prepared to act.

With terrorism, it is much easier to target individuals than the society as a whole, Giordano said. It is simpler to target specific groups and drum up a feeling of disconnect from their culture. Pain patients, especially, are vulnerable. Narcoterrorism is in many ways unique, he said.

The goal for physicians as moral actors is to render biomedically right and ethically sound treatment to those made vulnerable by pain as a disease, illness, or injury, he said. "Treating pain is different, because it's rooted in subjectivity," he said. "Pain conditions do not usually have a cure—the situations are not black and white."

Pain medicine is a social good; therefore, it is dependent on contingencies of the public sphere, Giordano said. It is important for physicians to serve as an agent to treat these conditions. However, part of the task involves collaborating and working with legal agencies. The question physicians have to ask is how can medicine engage, inform, and become sustained to protect against patient vulnerabilities. "Are the rules we have sufficient?" he asked the crowd. "Is pain medicine as politically aware as it should be?"

Giordano said that some argue that the nature of pain medicine is not well served by the guidelines that steer it and the policies that uphold it. "The issue is simple; if you want your house to be strong from without, it needs to be well built, well-constructed, and updated frequently from within," he said.

Part of the solution to preventing narcoterrorism will involve examining proper justice in pain medicine. The physician's role in determining which patients receive what should be more clearly defined, he said. When these interactions fail, or become tense, a rupture occurs.

Giordano highlighted two types of justice: communicative—an equal provision of goods based on equal need; and distributive—pairing of goods based upon the need to balance limited resources. Pain medicine should be seen as a social good, because it serves the needs of individual patients vested within the society, he said. The policies that govern it should facilitate access to knowledge, provide flexible treatment schemes and settings, offer awareness of limitations, offer learning opportunities, empower patients, and provide for the development and fortification of the patient-physician relationship.