Has the "drugs are bad" message gone too far?

Great Debates
1

This stems from the “Nation of Wussies” thread.

When I first started my clinical work a little over a year ago, I expected that I would see a lot of illicit drug seekers, as well as hypochondriacs who want a pill for every little malady. While I wouldn’t call them rare, I’ve been surprised at how few of these I’ve seen.

At the same time, I have been very surprised by the number of people on the opposite side of the coin. For every drug seeker I’ve seen, I’ve seen two or three people who are totally reluctant to take any drug of any kind. Never has a clinic day gone by when a few patients didn’t tell me that they weren’t “pill-taking people”. I once had a woman who broke down in the office and ultimately decided to go home and pray about it when I told her that her blood pressure was still too high and she needed to take HCTZ (a mild diuretic).

I understand when people want to avoid taking medication when they can. But take the example of a patients I admitted one night who had a pulmonary embolism, a blood clot that forms in the thigh, breaks loose, and lodges in the lung. He had been on Coumadin to prevent just that, but he had stopped taking it, because he “felt fine and thought he could get by without it”. No side effects, no worries about bleeding, not even the usual warfarin=rat poison objection. He just thought he should be able to get through this problem without taking a pill.

Others (probably a subset of the same group) look down with disdain at people who do take pills. This is most commonly seen against those who take psych medications, especially Ritalin and antidepressants like Prozac and Zoloft. They use the same terms that one might use to describe a heroin addict–“zoned out of their minds”, “doped up”, “pumped full of drugs”. (See the above-mentioned Wussies thread for examples in the wild.)

I think that this reluctance to take even indicated and properly prescribed drugs stems from the “drugs are bad” message that people have been pummelled with. Many people (including myself) often complain that the general message against drugs does a disservice by lumping marijuana together with crystal meth, but I think it goes further than that–I think it leads to “I don’t need Coumadin to get through my day”, or “Just say no to Lasix”, or “This (fried egg) is your brain on hydrochlorothiazide”.

Am I off base? Does anyone else think that the “drugs are bad” net has been cast far too wide?

Dr. J

2

As one of the assholes you’re probably refering to, I’ll take a stab at this:

I use drugs and such. I use antibiotics, tylenol, and the like. I draw the line when it comes to having a drug screw with my brain chemistry.

That being said, I’ve done the SSRI thing, and it gave me apparently permanent brain damage.

3

I don’t know if it is a result of the “Just Say No” campaign that has made people not want to take pills. I think that there have always been people who just prefer not to be chemically altered. My mother even refuses Novacain when she gets a tooth drilled! Now, I’m not one to rush to take a pill for every little discomfort, but for Christ sake!
Anyway, IMHO there has always been a large group of people who just prefer to tough it out.

4

I’m a “drugs are bad” person. I don’t take tylenol for pain or fever. I don’t take NyQuil, cough suppressants, anti-histamines, etc. I don’t like “drugs”.

Why?

Because I like to feel like I’m in control. I can fight off this illness by myself, I don’t need no steenkin’ pills. Headache? Bah. 103-degree fever? Feh. Childs play. I think it’s something of a control issue. Kind of “I’m in control, and I’m strong - I need no pill!! Ha!” I once was prescribed percocet for post-surgical pain. I never took one.

I’m the same way with injury. I just recently got a cut that probably needed 3 - 5 stitches. I put a band-aid on it. It’s healed nicely. Pneumonia? It’s a little cough. Broken finger? It’s a scratch. Gaping wound on my calf? It’s a little cut.

I don’t think it’s a result of the “war on drugs” in any way. I think I just want to prove (to myself or anyone who might be watching) that I don’t need that stuff. I’m self sufficient, and all that jazz. As smitty said, I prefer to tough it out.

I draw the line at antibiotics, mostly because I don’t want to contribute to the creation of a super-strep bug, or some such. I’ll take antibiotics as prescribed.

Don’t know if that contributes to the debate at all, but there you have it.

5

I strongly believe in “better living through chemistry.” What, precisely, that entails is really a judgement call.

As for the OP I’m sure that there is at least some correlation between the “war on drugs” and the attitude to which the OP refers. Drug users in the U.S. (and other countries) are demonized. If you get a person who (A) strongly dislikes drug users and (B) is able to come to the implicit understanding that the only fundamental difference between licit and illicit drugs is the way in which the law regards them, you might expect a strong personal aversion to drugs of any kind (which is not to say that there can’t be other motivations for aversion to drugs).

6

I’m with Smitty. I don’t think it’s a result of the “Just Say No” campaign. There has always been a group of people reluctant to medicate. I’m one of them, and I come from a family which was always the same way.

If I examined the reasons, I suppose I would say that in the back of my mind I probably think of medication as a sort of crutch and maybe a sign of weakness.I suppose I also have a sense that we don’t fully understand the side effects of all drugs, and I am reluctant to adjust my body chemistry in ways that may not be fully understood.

Part of it may also be that old Protestant/Scots-Irish ethic of self-reliance. I have to be virtually incapacitated before I will even see a doctor. DoctorJ, aren’t you in Kentucky? Maybe it’s an Appalachian thing?

Intellectually, I recognize that this is not a good approach to health care, but I have a mental block.

7

I think you are on-base, Dr. J, and I think there are two related aggravating factors.

First, fear of addiction is probably the greatest weapon in the drug warriors arsenal. It is certainly the reason that I would never touch certain drugs.
But the card has been overplayed. With most drugs (legal or illegal), the odds are strongly against a user becoming dependent (exceptions include nicotine, where the odds are in favor of dependence, and opiates, where the odds are against dependence, but not strongly so). It would not aid drug warriors to emphasize this point, and so they don’t (it is very difficult to uncover statistics on dependency - I had to go to UN websites to find them). So, a culture of fear has been deliberately developed. Not here to debate whether that’s a good thing or a bad thing, just to talk about the unintended consequences.
The culture of fear is amplified by the second factor - America’s innumeracy. We’re the people who think playing the lottery is a good idea, that we are more likely to get killed by a shark then driving to the beach, etc., etc.
So, we ain’t that bright, and the anti-drug campaign has accidently played into our endearing dim bulb qualities.

Sua

8

I agree, but it’s disappointing to see the message that (certain) drugs are highly addictive undermined by messages from the same people imploring users to quit. With nicotine, for example, studies have shown that young users tend to accept the messages in Public Service Announcements; that is, they believe that tobacco is bad for you, and they believe that they will be able to quit in a few years. A solid majority of teens who smoke believe that they will not be smoking in five years time. In most cases, that belief is mistaken.

I’d cite these claims, but I don’t have my reference material here at school, and I doubt I could find it online. I’ll give a look anyway. . .

9

another possible interpretation.

Especially re: Pain meds, my attitude has often been to tough it out knowing that ‘if it gets too bad, we go for pain meds’. Cause you see, if you’re on pain killers and you’re still in agony, there’s no hope.

Re: the other stuff (like blood pressure meds etc.) it can be something similar in that getting to the point where medication is necessary means you’ve crossed a threshold perhaps you wished you didn’t have to (sorta like the bittersweet moment the first time the ‘senior discount’ applies).

just a thought.

10

I very, very rarely take any over the counter medications. I mean if you have a headache and you take Tylenol all you are doing is covering up the symptoms of the headache, and not getting to the cause. Why put those extra chemicals into your body if your headache will go away on its own? Also, I have heard that it is better to have a fever because your body will fight off the infection better at a higher temperature than if you use a fever reducer (unless, of course, your temperature is life threatening). I will take antibiotics and other meds that a doctor gives me because I know those attack the cause of the problem, not just the symptoms. I really can’t say why I avoid over the counter meds, especially since I do several illicit drugs. Go figure. I guess I know I put enough chemicals into my system, so I try to avoid the ones that don’t give me a buzz :slight_smile:

11

I never really have the TIME to be sick. So if I have strep throat, or a raging headache, or a sprained ankle, I’ll find things to take care of it.

Not that I go for the aspirin every time my head hurts, but if it’s going to affect my school performance, it’s not staying around too long.

I’ve had plenty of mouth surgeries on a weekend and had to return to school the following Monday because I simply didn’t have the time to makeup the work I would miss. I took the very strong painkillers they gave me because otherwise I wouldn’t have been able to concentrate or even eat JELLO because of the pain. Of course, the pills diminished my concentration, but they didn’t turn me into a slobbering zombie.

I’ll take medicine if it helps me. I won’t if I think the pain’ll go away.

None of this has any bearing on the “Just Say No” campaign. I have a few friends that won’t take medicines for religious reasons. I have a LOT of friends who don’t take medicine because they really don’t think they need them.

12

This could very well be wrong, in which case I’m sure that DoctorJ or other knowledgable folks will fight my ignorance.

I typically avoid OTC drugs because of the reasons that Beelzebubba and others have stated: I like to feel in control. I’m not even making any judgements about the benefits vs. negatives involved; I just feel better about myself when I don’t take them… unless I’m really suffering. Occasionally I get kind of bad alergies. I also sing. If I’ve got a show coming up and I am really stuffed up, I’ll take a decongestant.

But, I have a hard time understanding the argument about “not messing with my internal chemistry.” Aren’t most stimuli we receive chemical. Don’t our bodies react in a chemical fashion? Sugar illicits a response. Protein. Certain vitamins. Whatever. Putting yourself in stressful situations. Putting yourself in pleasurable situations. Sex. Violence. All these things alter our internal chemistry.

What makes “drugs” in general any different (at least in the sense of not wanting to change one’s personal chemistry)? The argument that drugs are somehow unique in their internal-chemistry-altering nature just seems plain wrong to me (yes, let’s see how often I can use the word chemistry in one post).

13

A contributing factor may be the “natural living” philosophy that has been so popular since the late 1960s. I am wary of ingesting any sort of chemicals.

I do take some drugs (including antidepressants). But I try to minimize my drug intake. I avoid headache and cold medication. Taking “unneccessary” medication is a last resort. And IMHO, Novocain is very very neccessary.

14

So do you avoid taking ibuprofen or naproxin if you have muscle pains? Neither of those just “cover up” the symptoms, they are anti-inflamitories that reduce swelling, thereby possibly eliminating the cause of your pain. Many other OTC meds also treat the cause of pain and don’t just cover it up, like antacids for example.

I’ve never understood this attitude. Maybe so you won’t be in pain?

I have an extremely high pain tolerance, but never felt the need to be macho and suffer past the point where it was necessary. Pain also causes stress, which could cause its own problems as well.

15

If I don’t use this as my sig line, I will surely use it on ward rounds tomorrow. A great line! :smiley:

[sup][sub]I have nothing meaningful to add to this discussion. Please don’t gawk.[/sub][/sup]

16

I don’t think it has to do with the “Say No To Drugs” campaign.

I will take medication that I become informed about and believe with confidence that I need. I was having some weird concentration problems earlier this year and my doctor put me on Serzone. I really didn’t like how I felt when I was taking it…and after I got used to the side effects, I didn’t see any change in my personality. Hell, I didn’t even think I was depressed in the first place. When I missed a dosage, I would feel incredibly sick to my stomach. And even when I missed one day and took the next day’s dosage, it would feel like it was the first time I took it and I would be up all night. This is 4 or 5 months into it, too. Finally, I just said whatever and stopped cold turkey. That was two weeks ago…the side effects are gone, I have more energy, and I even feel better about myself. I’m not saying that all antidepressants or medications will do this, but I just think that doctors might prescribe certain medications without being completely informed about things.

I don’t like the idea of putting chemicals into my body that will have a strong effect on my body chemistry (I’m not talking about chemicals that give me nutrition, like food and drink.) I don’t take headache medicine or the like, and I’m going to be skeptical about any medications my doctor prescribes for me in the future. I guess when it comes to antidepressants, I think it is better to attempt to work out the problems than cover them up with chemicals.

Antecdotal evidence is never the best, but it is the best I can do to back up my opinion. Its not that I feel I should “tough it out,” but I guess I do want to feel that I am in control.

17

Holden Caulfield: I urge you to call your psychiatrist (or whoever perscribed the drugs) immediately. Stopping anti-depressants cold turkey can lead to big problems. (Believe me, I know!)

As to your problems with Serzone: All anti-depressants are different. Some work better than others for each person. Did you tell your doc about the side-effects and the lack of improvement? If not, then you must be more communicative. If so, you need to find a different shrink who will listen to you and adjust your meds accordingly.

18

I don’t believe it’s from the “war on drugs” either. I’m one of those people who generally avoids taking over-the-counter medication on principle, although I haven’t ever ignored or argued with a doctor’s prescription. Perhaps my reasons for avoiding over-the-counter medications will give you some insight.

  1. I don’t feel like they help much. This may be part of the way my brain works, but I’ve never, as far as I know, gotten relief from a headache from any kind of headache medicines. It may be that it takes a long time, and by the time it starts working, my brain has forgotten that I took the pill, so it doesn’t associate the relief with the medicine. Some people associate (for example) Tylenol with pain relief, so they automatically think of Tylenol when they’re in pain. I, however, do not, so there’s no incentive for me to take it.

  2. I’m wary of things – especially things which mess with my body – becoming a habit. This is not only about addiction, although that is a concern. When things make you feel better, you tend to look to them in times you don’t feel so good, sometimes regardless of whether there’s a logical connection. I’ve known too many people who habitually take some over-the-counter medicine or another. I dated a girl once who took Tylenol at least once a day. This worried me.

  3. If it’s a mild pain, I don’t want to cover it up, because I want to know if it gets worse, or if it goes on for too long. That’s an indication that I need to go see a doctor. If I had headaches on a daily basis, I might change my mind about this. I hate headaches, but I don’t get them very often. I usually just wait for them to go away, and they do. Emphasis on mild. It’s not a macho thing.

  4. I am extremely wary of trying to be my own doctor. Most people I know seem very confident about their knowledge of their own ailments and what drugs are good for them, etc, but I don’t think they know what they’re talking about. People recognize patterns, and they think they understand, but medicine is a complex subject. Last time the doctor prescribed you Medicine X for these symptoms, but he knows a lot about your insides that you don’t, and maybe things are different this time.

These last two reasons obviously aren’t applicable in a case where someone is refusing a doctor’s prescription. They’re completely based on the idea that a doctor knows more about this than I do, and that I should trust them. Maybe reasons 1 and 2 have something to do with the people you’re seeing, and maybe it’s other reasons. I seriously doubt it’s the war on drugs, though. After all, it’s just a war on illegal drugs.

Drugs that alter your brain chemistry (Prozac, Xanax, Zoloft, etc) are a bit of a different story, however. I’ve never had occasion to have them prescribed to me, and maybe if I did I’d see it differently (obviously my mind would be in a completely different state to start out with), but it gives me the willies to hear how many people get prescribed this stuff, given the effects they have. It’s not exactly an exact science. A friend of mine went to a psychiatrist and was prescribed Xanax on his first visit. The stuff absolutely put his brain in lockdown even at a quarter of the prescribed dose. He said it was horrible, as if he wanted to cry all the time, but was somehow incapable. He saw a different doctor who completely disagreed and didn’t prescribe him anything. Given the fact that Xanax is highly addictive, this frightens me.

19

Count me as one who doesn’t like to take drugs, but who doesn’t feel influenced by the “Just Say No” campaign.

I don’t like to take drugs because so many that have been recommended to me by doctors have made me much more ill than I was to begin with. In addition, I feel that they frequently fudge the truth when describing possible side effects.

To begin with, for years I suffered from mysterious and scary stomach pains. Doctors never seemed too worried about them, despite the fact that I felt like I was going to die, and after years of going through agony (and losing job after job through illness), I finally was sent to see a specialist. In an effort to make him understand how bad my pain was, I told him that, at times, I had considered killing myself to escape the pain. It’s true - you go through months and years of unrelenting, unexplained pains and try keeping a positive outlook. The specialist marked in my file that I was a suicide risk. Then he told me that I had IBS. Just knowing why I suffered the pains eased them - stress aggrevates the condition, and little is more stressful than thinking that you’re dying of some bizarre stomach disease.

So then I was also diagnosed with FMS. Now, FMS is often treated with anti-depressants, so they would have recommended them anyway, but doctors looked at my file, saw the note that I was a suicide risk, and started pushing for me to get on Zoloft in earnest. I tried taking it and other anti depressants but they made me seriously ill. However, when I tried telling doctors that, they told me that Zoloft was generally well tolerated, that if I could just get through the first week it would get better, blah blah. None would listen to me when I tried to tell them that Zoloft made me so sick that after a week I couldn’t take it because I threw up everything that I tried to swallow. So then they’d give me similar drugs with different names and tell me that they were more gentle - and the same thing would happen. I’d ask about side effects, and they’d say “Few people experience any side effects, but you may find your mouth gets a little dry”. Yet the warnings in the instructions listed a heap more than dry mouth, and I was suffering through all those things, but my doctors denied what I was telling them.

Then, I got viral labrynthitis around Christmas 1998, and was vomiting and dizzy and in a horrible state. The doctor put me on medication, and I took it, but I got worse, not better. Three different doctors made me keep taking that medicine, but added others to the mix, and still I didn’t get better. Finally, my SO read the booklet that came with the medication, and saw the side effects list - and saw that I was suffering from almost all the side effects listed! We threw the stuff away, and I got better immediately. While I understand that doctors aren’t all knowing, three doctors overlooked the fact that I was showing all the symptoms of a reaction to the medicine I was on, and kept prescribing other things to try and fix it, like anti-nausea tablets. I was too sick to be able to read, and couldn’t do much more than swallow my medicine twice a day and try not to vomit it up.

Ok, the moral of my story is that doctors have played down the side effects of medicines and prescribed them to me despite the fact that I’ve reported bad experiences with them in the past, and they’ve made me sicker. My FMS is bad enough that I don’t live a normal life anyway, I do not need to risk my health further with stupid tablets that don’t help and just hinder, and one bad tablet can make me sick for weeks or months. I’ve had painkillers for stomach aches that gave me stomach aches, I’ve had anti-depressants that aggrevated my depression, I’ve had tablets to cure nausea that made me vomit, I’ve had antibotics prescribed for conditions that aren’t treatable with antibiotics, I’ve had “FMS cures” that were the equivilant of Dad standing on my foot to “fix” an aching finger. I no longer trust most doctors or medicines.

I go twice a year to see my doctor who tells me he too hates Zoloft, and you know what he does for me that all those others didn’t? He says “You don’t take any painkillers for FMS? I admire you. You must be a strong person”. And I leave there feeling like all my struggles aren’t in vain, that someone else recognises what I go through, and that helps me deal with it. I don’t need painkillers or miracle cures, because Dr Joel admires my strength and recognises my struggle.

And lately, I’ve been much better. Go figure!

20

My family doctor prescribed it. I was going to a psychologist for a few weeks about halfway into my treatment, but my family couldn’t afford it anymore and I have since stopped. I told the family doctor about the lack of improvement and the withdrawal side effects. He said that a longer time with the meds would show more signs of improvement, but I wasn’t even depressed in the first place. He claimed that the withdrawal side effects were probably coincidental because missing one dosage wouldn’t cause that to happen. I know my body pretty well, and they weren’t coincidental. We don’t have a strong relationship with the family doctor or anything, we just go in whenever we need it, so I probably won’t see him about stopping cold turkey. I don’t mean to sound arrogant or anything, but I really don’t need antidepressants. I don’t feel like anything bad has happened since I got off the Serzone. I don’t doubt that something bad could happen, and I’m sure if something does I will eat my words (but my opinion of antidepressants will become much stronger.) But what do I know anyway?