Whose Fault Is It, Anyway?

All people in pain who are under treated or suffer non-treatment eventually ask this question.

In the beginning there is only a person’s body, the doctors appointment, the pharmacy line, the limited bottle of medicine, the printed label, the refill date, the remaining pills, and the days still left in the month.

Ordinary life keeps making ordinary demands, as though the body has not become a place of negotiation. Work still expects attendance. Children still need you to be an active participant in their lives. Bills still come. Food still has to be made.

The body may have become difficult to live inside, but the world continues as though difficulty were private. So the person does what responsible people do when they are given too little. They make it stretch. They become careful. They count. They ration.

They choose which hours deserve relief and which hours must be endured without it. They do not begin with a game of blame. They begin with arithmetic attempting to add everything up.

That arithmetic happens at the counter, in the bedroom, in the truck, at work, before sleep, after sleep fails, and in the small private moments where no one else can see what the month has become.

A person counts pills against days, days against pain, pain against work, work against sleep, sleep against family, family against dignity, and dignity against the need to remain composed in rooms where desperation can be written down as evidence of diversion from the approved path to an allowable amount of relief.

One pill becomes a work shift. One half dose becomes a night that might be hard to get through. One skipped dose becomes the cost of being useful tomorrow. One empty bottle becomes proof that the month was longer than the policy allowed for. The bottle says medicine was given. The body says it was not enough.

That is undertreatment. It is an epidemic unto itself. Denial is when the bottle never comes.

Undertreatment is when the bottle comes, the name is correct, the doctor is listed, the pharmacy is listed, the directions are printed neatly, the record can say treatment occurred, and still the person reaches the end of the month before relief reaches the end of the pain. Undertreatment is the epidemic that lives inside pain management. It gives the institution proof of mercy while giving the body proof of abandonment.

It’s enough to make a sane peaceful person two types of mad.

At the end of the month the patient becomes an accountant of their own suffering. The question is no longer only how badly their body hurts. The question becomes what pain can be afforded today so there is enough relief left for tomorrow.

Can sleep be sacrificed so work can be taken care of?

Can my family receive the patience they need from me if pain has already wore me down to the bone?

Can my body endure the errand, the meeting, the drive, the grocery store, the shower, the stairs, the chair, the bed?

This arithmetic looks responsible from the outside, and often it is responsible. It is discipline, restraint, an injured person trying to remain orderly inside limits set by someone else. But inside the person, the counting becomes something more dangerous. It becomes the doorway to resentment.

First comes the humiliation and self doubt. They think I am a drug abuser.

Then comes the injustice of the though… why am I being punished for what someone else did?

Then comes Righteous Indignation… I did everything right. Then comes the thought that someone else ruined this for me.

By that people people paint a face in their mind to blame.

This is where many pain patients get before they understand the healthcare system and passive prohibition system they are stuck in pursuingtheir health.

They were told the laws became restrictive because people became addicted.

They were told doctors became afraid because people abused medicine.

They were told pharmacies became cautious because prescriptions were diverted away from the people who need them.

They were told the system tightened because medicine had been misused, overused, sold, stolen, chased, demanded, all as propagandists turned it into crisis to be solved by an ever increasing amount of government control over our health.

This explanation comes with a visible human figure already attached to it. The addict. The person who took too much. The person who sold pills, who doctor shopped, and overdosed.

The person who became the public face of the need for passive prohibition.

So the patient looks at the empty bottle, the calendar, their body that is still hurting, the life still demanding function, and the mind completes the sentence it was given… addicts ruined this for everyone.

That conclusion has emotional order. It gives pain a shape. It gives resentment a target. It tells the suffering person, “You followed the rules. Someone else broke them. Now you are paying the price.” That story can feel like clarity when a person has been left with confusion. It can feel like justice when the body has been treated unjustly. It can make the humiliation less random because resentment prefers a face.

A person can imagine an addict. A person can picture misuse. A person can picture a bottle sold, a dose chased, a prescription lied for, a headline written, a doctor frightened, a law expanded.

The image is simple enough to carry. An understanding of our medical system is not.

That is why the anger has to be slowed down before it becomes doctrine inside the person that justifies their own suffering and subjugation.

The Truth is..

The addict did not write the policy. The addict did not set the quota. The addict did not audit the doctor, threaten the prescriber, frighten the pharmacist, discipline the license, design the red flag, narrow the supply, write the corporate rule, manage the shipment, build the registry, or turn medical judgment into law enforcement over possible future crimes.

The truth is drug addicts don’t control their own medicine and they definitely don’t have the authority nor desire to control your access to medicine.

The addict became the explanation because the addict was a diversion. Diversion control remained powerful because it had no single face and no real person to blame. It’s the kind of control that gets in your head to the point you’ll find yourself looking in a mirror honestly asking yourself and God am I the problem?

That question rises naturally from undertreatment. Pain seen and still left unanswered starts a person down a path that demands the asking moral questions.

A person can hurt, and then our system can add another layer of pain ontop of it.

The first pain belongs to the physical condition.

The second belongs to non-treatment, under treatment, suspicion, delay, and managed insufficiency.

A person left to ration medicine through the end of every month is not merely experiencing pain. They are experiencing pain after power has already spoken.

The person knows help was sought. The person knows the proper door was entered. The person knows something was given, and the person knows it was not enough. That knowledge becomes part of the injury in a take it or leave it medical system.

So the mind asks for blame because blame appears to promise order in an otherwise disorderly life. But the first object offered to the pain patient is usually too small.

Addiction became the loud explanation. Undertreatment became the quiet consequence. Addiction was named as the epidemic of . Undertreatment was treated as the cure. Non treatment being the ultimate goal.

Addiction was used to justify rolling emergency controls. And the war on drugs has now been used to justify the patriot act being turned inward.

Undertreatment was treated as the acceptable price of it all. The addiction epidemic received a public story. The undertreatment epidemic became the private problem of people sitting alone with bottles that emptied before the month ended.

An epidemic is not something people bring on themselves in the simple moral way public anger prefers. Often it is nothing more than social posturing of the politically active. As damning as it is the New Deal encourages them as tools of Progress.

A person being a threat to themselves cannot become a permanent excuse to deny relief to the harmless or fundamentally transform a society. The possibility that one person may misuse medicine cannot become moral permission to leave another person inside preventable suffering. When that happens, the system has moved beyond caution. It has begun sorting human beings according to their willingness to comply and bare sufferingfor the state.

This is where the distinction matters.

Drug control governs the illegal supply.

Diversion control governs the legal supply.

Most people think they are talking about drug control when they describe the suffering of pain patients.

They picture street supply, smuggling, criminal organizations, counterfeit pills, fentanyl, heroin, methamphetamine, cocaine, raids, seizures, prosecution, and the public theater of the drug war. That side exists. It is real. But the pain patient does not usually meet that side at the kitchen counter with an empty bottle. The pain patient meets the legal side. The prescription pad. The registered doctor. The licensed pharmacy. The manufacturer. The distributor. The quota. The shipment. The record. The policy. The compliance department. The approved hand.

Diversion control governs medicine while it is still legal. It does not begin with a bag on the street. It begins with medicine that remains lawful only so long as every approved person in the chain remains compliant. It stands over the prescription before it is written, the doctor before the decision is made, the pharmacy before the bottle is filled, the shipment before it moves, and the patient before the patient is trusted. It does not merely punish crime after the fact. It governs the possibility of criminality in advance.

It looks at lawful medicine and asks where that medicine might become unlawful later. It imagines future diversion and pushes that suspicion into the present. By the time the patient enters the room, the possible future crime is already standing beside them.

That is how medicine becomes suspicion. A person asks for relief, but the room hears risk. A person describes pain, injury, sleep, work, function, history, and failed alternatives, but the system has trained the room to hear categories.

Drug seeker. High risk. Opioid naive. Complex patient. Doctor shopper. Difficult. Noncompliant. Possible addict. Potential diversion. Future liability. The patient may be disciplined, sober, working, praying, parenting, paying bills, caring for others, and doing everything possible to remain useful inside a body that has become difficult to live in.

The system does not begin with the person’s life. It begins with the substance and ends at the policy with regards to the standard of care.

Once the substance has been morally transformed into vice, the person asking for it becomes morally transformed by proximity.

The DEA turned medicine into a vice. That is the plainest way to say it.

Strong medicine belongs to the long human story of pain, injury, surgery, age, cancer, war, labor, childbirth, dying, and the hard fact that bodies can suffer beyond the reach of polite endurance.

Diversion control changed the moral atmosphere around that medicine. It did not merely regulate relief. It placed relief under suspicion. It made legal medicine feel guilty before it was received. It placed the lawful supply under continuous supervision and then taught doctors, pharmacists, institutions, and patients to carry that suspicion into every room where mercy was supposed to remain possible but can rarely ever be found.

Doctors were turned into judges, juries, and law enforcement deputies over possible future crimes through policy. A doctor is supposed to examine, diagnose, treat, weigh risk, and act according to medical judgment.

Diversion control bends that role toward enforcement. It makes the doctor see not only the patient in the room, but the audit that may come later, the license that may be questioned, the record that may be reviewed, the dose that may look excessive to someone who never touched the body, the prescription that may become evidence, and the future event that may be blamed on the present act of mercy. The doctor begins practicing medicine while defending permission to practice medicine. That changes the room.

Pharmacists were placed into their own version of the same role. The pharmacy counter became a checkpoint where a legal prescription can still be treated as suspicious movement. A patient can arrive with a lawful prescription from a licensed prescriber for a lawful medicine at an authorized pharmacy and still feel the room tighten. The pharmacist may see inventory, policy, audits, ordering limits, diagnosis codes, distance, dose, timing, corporate pressure, and regulatory exposure. The patient feels the look, the pause, the delay, the partial fill, the refusal, the sudden claim that the medicine is not available, and the sense that need has become socially dangerous.

The patient does not meet the whole system at the counter. The patient meets a person. Resentment attaches itself to the person because the structure remains hidden.

Patients were turned into addicts or potential addicts to be categorized and managed. That is the humiliation underneath the resentment. A person may have lived carefully, worked through misery, refused recklessness, protected their family, endured pain with restraint, sought help only after private endurance was no longer enough, and still be placed under the administrative shadow of the addict.

Sometimes the word is spoken plainly. More often it is translated into professional language. High risk. Complex. Seeking. Dependent. Noncompliant. Resistant. Outside policy. Inappropriate. Requiring monitoring. Better managed elsewhere. Difficult.

The words may sound clinical, but the effect is moral. The patient is no longer only a person in pain. The patient becomes a category to be handled.

That is why “they think I am one of them” carries so much force. The patient is not merely objecting to a label. The patient is feeling the shadow pass over their identity.

They are feeling the word addict expand beyond the addicted person and become a governing suspicion that can be placed over anyone who needs controlled medicine. The system can use the addict as the explanation, then treat the pain patient as though the pain patient belongs under the same accusation, then use both as evidence that tighter control is necessary.

The pain patient says, “I am not one of them,” because the pain patient is trying to defend the self. Diversion control is not listening for the self. It is sorting risk.

This is where sporting people have to remember who they are.

A sporting person carries pain with discipline instead of surrender, responsibility instead of bitterness, and composure instead of shame.

A sporting person does not confuse suffering with permission to become unjust.

A sporting person can be angry without making the wrong person pay for the wrong thing.

That does not mean accepting undertreatment. It does not mean thanking the system for too little. It does not mean calling abandonment caution or calling suspicion care. It means refusing to let resentment become another authority over the soul.

It means not allowing the world to harden your heart or force you to carry a chip on your shoulder.

Compliance is often mistaken for responsibility, and prudence is often mistaken for rebellion. Compliance, in the medical system, often means agreeable, manageable, willing to accept direction, willing to move through approved steps without making the institution defend itself.

That is not the same thing as responsibility.

A prudent person asks who is qualified, what the risks are, what the alternatives are, what the consequences will be, what happens if the decision fails, and who will carry the cost afterward.

A prudent person does not surrender judgment simply because an authority figure has spoken. Yet a system built around compliance may call prudence difficult, resistant, or noncompliant. It prefers the person who can be managed.

HHealth however is not the same thing as manageability.

The same mistake governs pain medicine. The compliant patient is easier to handle. The patient who accepts undertreatment quietly protects the system from confrontation. The patient who rations pills, hides distress, avoids direct requests, thanks everyone for too little, and performs calm while the body is breaking may be considered reasonable because the suffering creates no trouble for the institution.

The patient who says the bottle does not reach the end of the month, the dose is wrong, sleep is killing me, the alternatives have failed, and life cannot continue this way becomes a problem. The problem may be real medical information. The system may hear risk. What everyone sees however is hard money to be made.

That is where resentment begins again. But resentment must be slowed before it becomes identity. A person who lives by resentment has allowed the system to keep governing them after the appointment ends. The system has already rationed the medicine. It has already limited the potential of life. It has already placed suspicion between the body and relief.

If resentment then teaches the patient to hate addicts, hate doctors, hate pharmacists, hate other patients, hate the self, and hate the world for continuing, the machinery has reached deeper than policy. It has entered the soul. It has turned suffering people against one another while the structure remains unnamed and protected.

It is easy to be angry at something with no face to blame. It is harder to stop being angry when there is no face to forgive.

That is the cruelty of systems. A person can replay the doctor’s voice. A person can remember the pharmacist’s eyes. A person can picture the addict they have been taught to resent. Faces remain. Systems do not.

 

This is why resentment so often lands on the nearest person. The addict has a face. The doctor has a face. The pharmacist has a face. The system itself remains somewhere above the room, working through paper, policy, language, and fear. It turns suffering into procedure, then lets procedure look like individual choice.

The doctor says no, so the doctor looks responsible. The pharmacy refuses, so the pharmacist looks responsible. The patient is told addiction caused restriction, so the addict looks responsible. Everyone sees the person standing closest to the denial and mistakes that person for the author of the denial.

No one is responsible in the simple way resentment wants though. That does not mean no harm has been done. Harm has been done everywhere. It means the ordinary blame game won’t work.

Most people are performing roles inside a structure that tells them their role serves the greater good. The doctor believes caution protects the public. The pharmacist believes scrutiny prevents diversion. The regulator believes compliance saves lives. The policymaker believes restriction prevents abuse. The institution believes risk management protects everyone from catastrophe.

Even the suffering patient, when trained to blame addicts, believes the anger is aimed at the true source of the loss. Each person carries a partial explanation that feels morally complete from inside. That is how systems survive. They do not require everyone to be evil. They require everyone to be secure enough in the righteousness of their part that the whole arrangement continues on.

Diversion control is the system that made everyone feel responsible while removing responsibility from everyone. It created a chain of approved hands and then placed fear along the chain.

It separated the haves from the have nots.

The haves are not merely people with pills. The haves are people who still possess medicine, trust, approved status, institutional access, clean records, cooperative doctors, and social respectability.

The have nots lack medicine first. That is the immediate wound. But once medicine is gone, they soon discover they lack something else as well. They lack the marks of trust that make medicine reachable.

The separation is not always announced. It often appears as caution, policy, practice standards, risk screening, dosage limits, insurance rules, shortage language, pharmacy discretion, referral delay, taper plans, non-opioid alternatives, or the quiet refusal to say what everyone in the room knows. The person in pain is not always told, “You are untrusted.” They are simply treated as if trust would be dangerous. They are not always told, “You are being abandoned.” They are given something too small and told to be grateful. They are not always told, “Your suffering is acceptable collateral damage.” They are told safety must come first.

They are told the rules have changed.

Rules are powerful because they make moral choices look automatic. Once a rule exists, the person enforcing it can feel relieved of authorship. The doctor can say policy. The pharmacist can say regulation. The hospital can say protocol. The insurer can say coverage criteria. The board can say standard of care. The agency can say diversion prevention. The politician can say public health.

Each answer is limited enough to feel true and incomplete enough to hide the whole of the truth.

The patient hits a wall of borrowed authority.

No one person appears to be choosing the pain. Yet the pain remains chosen by the structure. The refusal has been distributed so widely that no single hand feels dirty.

This is how authority moves upward while blame moves downward. The patient blames the addict. The addict is blamed by the public. The doctor blames policy. The pharmacist blames compliance. The institution blames liability. The state blames crisis. The federal agency blames diversion risk. The lawmaker blames public demand for safety. Meanwhile the suffering person at the bottom is left with the consequences.

Authority rises into abstraction. Blame falls onto bodies. The people who hurt can see one another, resent one another, accuse one another, and misunderstand one another, while the machinery that arranged the room continues to call itself necessary.

The phrase “legal drug cartel” matters because it reveals the insult hidden in plain sight. The lawful supply of controlled medicine is treated as a federally supervised chain of approved handlers. Manufacturers, distributors, prescribers, pharmacies, hospitals, researchers, and other registrants may handle controlled substances only inside permission.

The medicine is legal, but legality is conditional.

Every movement must remain inside the approved path. Every hand must be authorized. Every transaction must be accountable. Every departure from lawful purpose is imagined as possible diversion.

The patient at the end of that chain is not treated as the owner of a need, but as the final risk in a system terrified of what might happen after the bottle leaves approved hands.

That is why the pain patient’s resentment is understandable. The patient did not ask to become part of a federal theory of risk. The patient asked to live.

The patient brought a human problem into a medical room and found an enforcement shadow already there. When the answer came back smaller than the suffering, the patient looked for the reason. The reason they were given was addiction. The person they were told to picture was the addict. The anger did not come from nowhere. It came from the explanation provided.

But the explanation was not enough.

The addict did not create the legal drug cartel.

The addict did not decide that lawful medicine would remain legal only under continuous supervision.

The addict did not create the distinction between approved and unapproved hands.

The addict did not teach the state to govern medicine through the possibility of future misuse.

The addict did not build a world where a doctor must think like a healer and a suspecting officer at the same time.

The addict did not make pharmacists fear the lawful prescription in the hand of a suffering person.

The addict did not turn pain into a category to be managed.

The addict did not turn prudence into noncompliance, knowledge into a threat, or need into a cause for subjugation.

Once the reader sees that, the addict becomes less useful as an object of anger. Not because addiction is harmless. Not because diversion never happens. Not because misuse never occurred. But because the addict cannot carry the weight of the structure built in the addict’s name.

The addict became the public explanation for a machinery that reaches far beyond addiction. That machinery now touches chronic pain patients, post surgical patients, injury patients, cancer patients, elderly patients, disabled workers, veterans, people with spinal damage, and people dying under medicated and victims of non-treatment.

It touches people who never sold anything, never chased anything, never lied for anything, never broke the law, and never asked for more than the chance to live inside their bodies with some measure of mercy and dignity.

That is the non-treatment and undertreatment epidemic.

It does not always leave bodies in the street. It often leaves people in recliners, bedrooms, job sites, waiting rooms, cars outside pharmacies, kitchens at midnight, and bathrooms where they can cry without frightening the family or the shame of peers.

It leaves people awake while the household sleeps. It leaves people choosing between pain relief for work and pain relief for sleep. It leaves people taking less than prescribed because they know the bottle will not reach the end. It leaves people ashamed of needing medicine and ashamed of not functioning without it. It leaves people spiritually exhausted because the body’s suffering has been joined to suspicion of their character.

Suspicion changes the soul if the person does not resist it. A person treated as suspect may begin to defend themselves even in empty rooms. They rehearse explanations no one asked for. They imagine accusations before they are spoken. They become careful with language, clothing, tone, posture, and facial expression. They learn not to look too desperate, too informed, too angry, too poor, too tired, too certain, too insistent, or too relieved. They learn that asking directly for what works can be dangerous. They learn to perform reasonableness for people already trained to hear need as risk.

This is where many people begin to hate.

They hate the doctor for cowardice. They hate the pharmacist for judgment. They hate the addict for ruining trust. They hate the government for cruelty. They hate family for not understanding. They hate themselves for needing what has been made shameful. They hate the body for creating the need. They hate the month for being longer than the bottle. That hatred may feel like strength at first because anger gives energy to a person weakened by pain. But anger cannot become the home. Resentment cannot be the doctrine.

If resentment becomes the organizing principle, the person’s life is still being governed by what harmed them.

Letting it go does not require pretending the harm was small, nor does it require calling the system innocent. It does not require excusing every cowardly choice, every cold refusal, every humiliating question, every undertreated month, every night lost to preventable pain, or every record that renamed a responsible person as a problem.

Forgiveness requires something harder. It requires forfeiting the right to vengeance when vengeance has no clean human target. Resentment asks for recompense. It wants someone to pay. But when the object is a system, vengeance has nowhere clean to land.

So it lands on the nearest face. The addict. The doctor. The pharmacist. The patient who received medicine. The person who looks like the last person to deny adequate care.

All of this is how diversion control keeps suffering people bound to one another in accusation instead of freeing them to see the structure.

That is why the question “Whose fault is it?” must be asked honestly seeking malice towards none and it must be answered carefully.

If the answer is “addicts,” the pain patient remains trapped in resentment toward a visible class of damaged people.

If the answer is “doctors,” the patient may miss how the doctor’s role was changed.

If the answer is “pharmacists,” the patient may miss the compliance pressure that turned the counter into a checkpoint.

If the answer is “us for our own good,” the system has succeeded in making suffering people blame themselves for needing mercy.

The real answe is this… diversion control is to blame as the system that converted medicine into suspicion, separated the haves from the have nots, divided the compliant from the noncompliant, and taught suffering people to see one another through accusation.

Once that is seen, the emotional burden can begin to change. The pain patient no longer has to hate the addict to explain the empty bottle. They no longer have to hate the doctor or the pharmacist to recognize the pressure at the counter. The patient no longer has to hate themselves because their body requires strong medicine.

The resentment can release because the explanation has improved. Blame was what the mind reached for when it lacked structure. Structure gives the mind somewhere else to stand.

That is the mercy of understanding. Understanding does not make the bottle fuller. It does not guarantee the doctor will listen. It does not force the pharmacy to fill. It does not erase the record, restore the old trust, or undo the nights already lost. But it can stop the person from being consumed by the wrong fire.

It can help the patient stop blaming addicts for a machinery addicts did not build. It can help the patient stop seeing every professional as a personal enemy when many are frightened functionaries inside a larger system.

It can help them name diversion control instead of merely cursing the faces placed in front of them.

That is why this article exists. It is not here to hand pain patients a new enemy. It is here to take away a false one. The addict did not take your medicine. The addict was made into the face of the explanation. The doctor did not invent our medical system. The doctor was placed inside it. The pharmacist did not create the permission slip. The pharmacist works at one of its most limited choke points.

You did not fail because your body needed narcotics. You were made to feel guilty because relief was placed under suspicion before you reached for it. The question is not whether anyone has ever misused medicine.

The question is whether misuse by some justifies undertreatment of the harmless.

It does not.

The suffering I have seen, and the gnashing of teeth of angry people searching for who is to blame, is why I wrote Mr. DEA’s Diversion. I wrote it to lay all the cards on the table.

Not to give suffering people another face to hate, but to show them the machinery that made enemies of people who should have recognized one another. Pain patients, addicts, doctors, pharmacists, families, and frightened professionals have all been placed under the same shadow in different roles.

Some were denied. Some were accused. Some were made handlers. Some were made examples. Some were made afraid. Some were made to enforce what they did not create. Some were made wealthy. The resentment between them all serves the system because it keeps the system unnamed.

A person in pain eventually asks whose fault it is. That question deserves more than a scapegoat. It deserves history in answer clean enough to let the suffering person breathe again without needing vengeance.

That is where Mr. DEA’s Diversion begins and hopefully ends.