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Tuesday, July 5, 2011

Opioids and Antidepressants - Trials for the Innocent

The trials of Job
A number of current articles discuss how modern medications can have profound effects on peoples lives - and not always for the good (see "How Real is That Pain" and "Studies Examine Autism Links to Antidepressants").

Having been around for half a century now I've been thinking back as to what people did for things like pain and depression when I was a kid.  Certainly things were much different.

Along the line of opioids and pain the only real pain killer (at least by today's standards) available was morphine.  Basically this was used to help grandma in the last days before death, from say, cancer.  This was not typically given to "take home" and was administered only after great hand wringing by the family.

There was also aspirin - and later Tylenol and ibuprofen.  Tylenol was invented in the mid 1950's and first sold as an elixir for children - however, at least where I lived - it wasn't readily used on a household basis until after the 1960's.  Ibuprofen was not invented until the 1960's and not launched in the US as a pain killer until the mid 1970's.

If you broke a bone, say at the roller rink, there were no pain killers - you just had to touch it out.  One of my best friends in grade school had a cyst removed from the top of his hand - he came to school and showed it off - he could unwrap the bandages and you could see the tendons moving when he moved his fingers.

As for depression - there were no medications - just talk therapy if you had a bad case.  Of course, there were always the usual home remedies like Jim Beam.  As a kid most parents wouldn't tolerate you lying around acting depressed.  You were forced outside, to school, and so on.  You were made "functional" regardless of your mood by parents, school and responsibilities.

There were no basements full of video games to hide in.  About the best you could do hide out if you were depressed was get a pair of headphones and "listen to the stereo" (using vinyl records).  Music was about the only modern conveyance available (at least compared to my own parents - who had "radio") to allow one to "escape".

Compared to today life was far, far simpler.  Certainly there were deaths, suicides, abortions, and so on in the high school I attended.  But all of this had little effect on the "general" population.  There were maybe 900 kids in the high school I graduated from - one suicide in the four years I was there - but depression was completely unknown as the "disease" it is today.

A lot has changed in the 35 years since I graduated from high school.

Opioid addiction is rampant (15% to 20% of all prescriptions being abused, prescriptions handed out like candy, prescription pain killer addiction the fastest growing drug problem).  A few years ago I broke my wrist.  Opioids were literally forced on me:

"No" the doctor said, "I won't reset your wrist unless you take this morphine." 

A negotiation ensued and it was reset only after I agreed to the smallest possible dose.  Did it hurt?  Not really.  The the morphine make a difference - no.  (No doubt just some "standard procedure ass-covering.)

But then again I knew how to take a beating - having older cousins and friends that we would fight with after school.

A week later I had to have surgery on it.  As I awoke from the surgery there was the nurse pumping me full of fentanyl.

"What's that for?" I asked still groggy. 

"Your pain" the young nurse replied. 

"Well, I don't want it."

There was a long pause. "What?" she replied.

"You heard me," I said, "I don't want that."

She seemed genuinely confused. "We don't want you to be in pain."

"If it doesn't hurt how will I know when its better?" I replied.

She stopped with the fentanyl - finally - but only after handing me a handful of opioid pain pills.

I had broken my wrist during an ice storm.  The next morning the power was out and I had to get the generator going - drive to the gas station, get gas, dump out the old gas, get the thing up to the house and running.  I discovered that if I kept my arm up over my head I could get by...

The memory of the pain from my wrist today still gives me pause to be more careful on the ice - would I be less careful without that reminder? 

No doubt.

As I wrote in "Failing our Future" depression is often a tool for reflection on past disappointments and mistakes.  Take that away and there is far less "learning" from previous mistakes.  (Maybe if I hadn't treated my significant other like shit they would still be here... gasp! was it "my own fault"...?)

I think depression, like pain, is a powerful tool for triggering the reevaluation of your life and its trajectory.

So, in the last 35 years society in general has lost its ability to learn from mistakes, both physical and mental, through the introduction of drugs which basically remove the consequences of those mistakes.

Pandora's box has already been opened, the genie out of the bottle.

Why will (or would) anyone want to go from a drug-induced stupor (or drug induced "happy place") back to the real world?

They won't.

These drugs are a Fustian bargain with Satan for "smooth sailing" today at the cost of future addiction, dependance, side effects on you or your unborn child, and on and on...

The 1960's drug culture has most certainly helped this entire process along - drugs make you "feel good" - yes, that may be true, until you sit down and factor in the real costs (like addiction, teen drug use, etc.) over time.

Pain, depression and suffering have been among the lynch pins of humanities struggles and triumphs over all of recorded history. 

Where would our history be without these?

I think that the future history of this time will be very interesting.  Interesting because the pain and depression these drugs are supposed to have eliminated will instead merely be shift from the selfish to the innocent. 

The innocent, like Job, will be forced to endure all manner of plague, suffer, and the like...

Will they discover that only be accepting the true pain and learning to deal with it will the cycle be broken?

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