Posts Tagged ‘drug addiction’

Pain Pills and their ugly cousin: Part 1

Thursday, December 20th, 2012

I had a total knee replacement nearly twelve years ago. On the Orthopedic ward I was told I could have one or two strong pain pills every 4 to 12 hours depending on how much pain I was experiencing. Since I have a fairly high pain threshold I decided to take the minimum dose, one every twelve hours. I took the first pill, felt considerable relief from the pain, but also felt strange, so I stayed at that dose.

One way to flex & extend after a total knee replacement

Then I ran into a snag. My release from the hospital depended on the degree of flexion I could achieve in the leg with the new knee. Several times a day I was hooked up to a device that gradually bent my leg. It really hurt, but I toughed it out. The nurses and the physical therapists (PT) didn’t seem to communicate with each other and I was a bit slow to catch on.

“You’re not making enough progress,” my surgeon said. “I think we’ll have to extend your stay.”

Something finally clicked in my mind. I was hurting enough so the ward staff hadn’t set the machines degree of flexion higher. I decided to take two of the pain pills an hour or so before the PT appeared to check my ability to have the leg bent passively.

This time I was in no pain, although I did feel weird.

“You’re doing much better today,” she said. “I’ll tell your doc you can go home tomorrow.”

I had been given a strong pain pill, probably oxycodone and they were going to give me a prescription for several weeks worth to take at home. I asked, “Can I have extra strength Tylenol instead?” I repeated that request when I had low back surgery six months later.

Since that time there’s been considerable controversy about strong pain medications. The initial question was whether physicians were under-prescribing for patients with severe pain, usually cancer-related, in fear of getting them “hooked” on the drug. Subsequently there have been at least two tidal shifts in how pain medicines are viewed, one urging more treatment of pain including giving the most potent meds for chronic non-malignant pain (CNMP) as well as for cancer patents (who clearly needed to have adequate pain control and weren’t always getting it).

Very recently there’s been a re-evaluation of the trend. I want to go back to the basics and then follow the timeline of expert opinion that’s been expressed on the subject in the last two hundred years. But I’ll begin much further back than that.

A 2008 article now available online and authored by staff from the National Development and Research Institutes and from the Department of Pain Medicine and Palliative Care at New York City’s Beth Israel Hospital explored the treatment of chronic pain in depth. A few comments from that article surprised me.

a field of opium poppies

In Mesopotamia, nearly 5,500 years ago, Sumerian farmers cultivated a plant called Hul Gil which translates as the “joy plant.” We call it the opium poppy. An August 2002 PBS special titled “Bitter Harvest” walks through how this plant is processed into the highly potent street drug, heroin, with at that time 13 million addicts worldwide The United Nations Office on Drugs and Crimes (UNODC) has a 2009 paper online estimating similar numbers. The major alklaloid (a usually colorless, complex and bitter organic chemical) in opium  was isolated in 1903 and named morphine (the Greek god of dreams was Morpheus). Then the Bayer company made a chemical from morphine and gave it the brand name Heroin.

Nowadays much of the world’s crop of opium poppies is grown in Afghanistan. The 2009 estimate from UNODC was for $60 billion of the worldwide total of $68 billion.

But I’ve strayed away from my theme, which isn’t street drugs, but prescription medications, so I’ll stop here and get back to the synthetic opiods in my next post..

 

Meth Madness: Part 2

Sunday, January 1st, 2012

Users of both genders and all ages abuse this drug

I want to be perfectly clear: methamphetamine use is a terrible plague in our society.  Although overall numbers are down over the past decade, we’re still talking about a million plus people in the United States, many of whom are young and heterosexual. But, of course, that’s not the only population group with members who abuse the drug; The CDC factsheet on its risk for HIV/AIDS stresses it can contribute to sexual risk behaviors, regardless of the sexual orientation of the user. I spoke recently to a long-term friend who is gay.  I asked him about its use in the gay community and he replied, “Everyone I ever knew about who used meth is dead.”

There’s a brain chemical called dopamine that affects how we experience pleasurable activities. Lab experiments show this highly addictive and illegal drug can lead to considerably greater dopamine being released than either eating or having sex.

A user experiences a high, a “rush” much more intense than from any normal activity. But there’s a problem; it doesn’t last more than eight to 24 hours. And it’s not as intense in succeeding uses. So that leads to a pattern of addiction, the need for not only repeated  drug use, but more and more of the substance.

Chronic, repeated meth exposure, whether by oral ingestion, ‘snorting”, smoking or injection, clearly leads to damage in the brain, the teeth and the skin.

An online review by the  National Institute on Drug Abuse, part of the National Institutes of Health, says imaging studies (e.g., MRIs) done on meth addicts show alterations in parts of the brain involved in motor skills, verbal learning, emotion and memory.

I went back to the PBS special, “How Meth Destroys the Body” and was stuck by the graphic photos of “meth mouth.” A common sign of abuse of this drug is severe tooth decay. The cause is uncertain, but meth does lead to shrinkage of a user’s blood vessels and the mouth requires an adequate blood supply to stay healthy. The addicts often binge on high-sugar foods and drinks; their mouths lack sufficient saliva to maintain optimal healthy oral tissue and, on a high, meth users often grind their teeth and, of course, forget to brush or floss.

Between the tooth decay, the increased physical activity frequently experienced and the failure to eat adequately, meth users lose weight and look older.

the model of meth's structure looks benign; it's not, though!

They also lose interest in any activities other than those related to obtaining and snorting or injecting the drug. Men may become impotent; women may lose their interest in sex.

So why don’t we require simply prescriptions for the cold and allergy pills that contain psudoephedrine, the chemical I mentioned in my last post that is used in the production of methamphetamine? I read an article in the 20 December 2011 edition of the Annals of Internal Medicine which told of the widespread abuse of controlled substances in the United States. It wasn’t describing illegal drugs, just ones that normally do require a doctor’s prescription. Many of these can now be purchased on the Internet.

That series of photos of meth users mouths and “before” and “after” photos of addicts may be one place to start.