In mid-February, one could read that a Midwestern governor, himself a doctor, whose wife lay dying of bone cancer adminsitered against her pain a "for horses only" arthritis solvent and other illegal substances. A bit later came the story of a noted Washington newspaperman who, similarly wracked by cancer, took his own life with a gun. Who is not familiar with the situation of a person so wretchedly in the clutches of terminal cancer as -- in words Nikita Khrushchev once applied to nuclear war -- to make the living envy the dead?
A certain fatalism often creeps into people's thinking about this sort of pain, a sense that it is inevitable, or at least unavoidable; God's will, some say. There can be a deference to doctors who are showing great compassion and enterprise to bring comfort by other means to their cancer patients' final days. But there is also the pain and, afterward, among those who observed it, there is an eagerness to see that others do not pass unnecessarily through the same ordeal.
Unnecessarily: Illness, cancer, death are not cost-free. But what is poorly understood by a surprising number of the people whose experience makes them feel knowledgeable about the subject is that there is something that can be done about pain not relieved by available analgesics. Provide heroin.
We arrive at the dread door. Heroin is addictive and therefore criminal, criminal and therefore unavialable to lawabiding citizens on their deathbeds, although -- painful irony -- it is available abundantly to law-breaking citizens on the street. But heroin is also, by common agreement, a marvelous painkiller: powerful, fast-acting, quickly soluble and therefore easily given by injection to patients beyond the reach of other analgesics administered by other means. there is a surfeit of expert testimony that for certain cases, nothing is as good as heroin.
As it happens, heroin was used thereapeutically in this country from the late 19th century until into the 1930s; it was banned because it produced addicts. Only in the last few years has there been concerted lobbying to bring it back. The main push has come from the National Committee on the Treatment of Intractable Pain (P.O. Box 3457, Washington 20034).
Last year, Rep. Edward R. Madigan (r-Ill.) introduced a heroin bill and Rep. Henry A. Waxman (D-Calif.) gave it a day of hearings in his Commerce health and environment subcommittee. Madigan says the venture went well. An earnest, carefully spoken man, he felt it helped that he was coming at it as a conservative. He introduced new legislation yesterday. The idea is to permit (seized) heroin, supplied through the National Cancer Institute, to be used for certain cancer patients in hospital settings.
It is an uphill battle. The principal opposition comes from the drug enforcers, who stress their fear of diversion of legal heroin to illegal use, and from various federal health professionals, who argue, essentially that other drugs, used better than they now are used, can do the job and that, meanwhile, research on alternatives proceeds apace.
To these objections there are, I believe, good answers. To the diversion argument: Britain has permitted the therapeutic use of heroin for 80 years, and some 30 other countries for lesser periods, and they have somehow coped with the security problem. To the medical argument: Do all the research you want on other drugs but meanwhile give doctors the choice of prescribing heroin for selected patients. Its efficacy is undenied; it's safety, for terminal cancer victims, is irrelevant.
Still, a lot legislators are going to have to be coaxed out of the caution that commonly takes hold when the question of legalizing an addictive drug comes up. And even if the impediments to legal prescription are removed, the requirement will remain to prod the law enforcement, health and drug bureaucracies to make anything like the Madigan approach work. The DEA's hard-nosed stance is not, evidently, just for show. The NCI has not exactly leaped to follow through on the far easier program of making marijuana available to relieve the side effects of chemotherapy.
Madigan, who says the subcommittee is aboard, and Chairman Waxman, who says he will push the bill hard, detect an improving legislative climate for a heroin bill. Congressional wives are talking up their husbands, Madigan reports, and the Committee on the Treatment of Intractable Pain gets around. Cancer gets around, too, and the witnesses remember.