Dr_Paprika: Thanks for the input, I’m now quite convinced that Fentanyl sedation is an accepted and common practice, I just hope someone out there can perhaps understand why I initially a bit suprised with the notion. In actual fact another GTA doc, a pediatrictian with privledges at St. Mikes & Women’s College, was the one to inspire my inquiry.
Oh, I understand why you were surprised. We (and I mean we nonmedical folks) have been quite well brainwashed by OPIATES BAD stories from the media and government. (And really, what good is there to say about street herion abuse?). When my son (also at Shriner’s) was given morphine, I kinda freaked out a little on the inside. Oh, my gosh, my almost teenaged son is being given morphine, he’s gonna get hooked and become a junkie and I’ll never be a grandmother…or something like that.
There’s a lot of scare tactic “one time use and your life is over” stuff out there, and it’s easy to forget that recreactional use by a well person is nothing like therapeutic use by a trained professional on a person who legitimately needs the stuff. Lots of pain + morphine = pain relief. No pain + morphine = euphoria. (Simplified, but you get the idea.)
So I totally understand where you’re coming from. It’s understandable to be frightened of addictive drugs. Just remember that used properly in a medical setting, they have very valid uses.
A friend of mine died in 1994 of bone cancer. (We were both fourteen at the time.) She was being treated by that big children’s hospital in Tennessee (whose name currently escapes me).
She would sometimes scream uncontrollably from the pain. I once asked her why they didn’t give her more pain medication, and she said that it was because her doctors were concerned she would become addicted.
I was flabbergasted. The girl was terminal. Addiction was the least of her worries.
Now that’s just wrong. I prescribe narcotics rather carefully, and then generally only for significant acute pain, and also for malignant pain syndromes. Most everything else gets non-narcotic pain therapy. But the pain from metastatic cancer is certainly malignant pain, and merits adequate treatment, including adequate opiate narcotics. And sometimes “adequate” is “enough to stun an elephant” when the disease progresses and tolerance occurs.
I concur, bone ca is way painfull, hardcore narcotic pain control is the standard of care. Your friend was robbed (ok, I don’t know the whole story).
I once had a LOL (little old lady) with liver mestastasis (cancer is spreading)who came into the ER for resp distress secondary to acites (fluid building up in the belly). So we tapped her belly and drained the fluid off and she went home. But here’s the rub; she’s about 70 years old, weighs about 80 lbs, is on a home PCA pump running 40 mg of morhine every hour, plus she can give herself 20 mg more every 30 min. I gave her an extra 10 after the tap and she got up and walked out with 90mg of morphine on board. I weigh about 210 lbs and 1/2 that much would kill me deader than shit.
In end stage cancer it’s not unkown to use high dose narcotics, oral amphetimines, and a benzodiazpine to give someone a semblance of normal function
<magic portal to a not-yet-created GD thread> just a passing thought…and probably one that should not be addressed incase it should upset the MODs, but from this discussion I can kind of see why ‘shooting galleries’ i.e. medically supervised recreational heroin facilities could be a really good thing, based on the anecdotal evidence, we seem to have estabished that opiates (opioid is the same thing?) can be easily administered very safely with few side affects in medical settings…</magic GD portal>. I’m sure the issue is vastly more complex but as I said, just a thought.
Um, I’ll pass. I’ve got enough work to do without adding on the supervision of a bunch of practicing junkies. I’ll help them when they are sick, and point them toward detox and rehab. I will not supervise their use to try to minimize the consequences of their shooting up.
I don’t think highly trained MDs would really be needed, I mean presumably it might be nice to maybe have just one around but I’m thinking that its probably quite possible to staff such a place with technicians or other skilled but not overqualified persons to help prevent what I can only assume are significant social problems (ODs, spread of disease & assorted suffering).
Considering I walked into this thread utterly clueless on the subject I might be best served to quit speaking quite completely through my hat…
I’m a 12 stepper, I couldn’t participate in such a program.
‘Shooting galleries’ not required.
I note she talks of “someday” being ready to come off of narcotics. Speaking as a recovering junkie who has been clean and sober for well over 15 years, and has taken care of a few thousand addicts, she should really make “someday” be today. Half measures availed me and most folks like me absolutely nothing.
Gyan: Factually speaking (because thats what we do in GQ 
), the article you linked to does promote methodone clinics which I believe you will find are very similar to the shooting galleries I had broached. The important difference is here:
*
The NHS allows only licensed doctors to prescribe diamorphine, the medical name for heroin, to addicts if they have failed to respond to methadone treatment*
Thats a neat idea! I might still take issue with the fact that the gov. is casting aside persons who wish to safely but regularly use the full-on euphoric version of the drug rather than get weened off, its certainly a progressive policy making a positive impact. I think it would remain ideal to focus on harm reduction even in the case of addicts, assuming funding for the program wasn’t an issue (big assumption yada yada). Ultimately the question in mind mind is whats worse: drug addicts getting their fix or drug addicts getting the same fix while simultaniously spreading HIV?
I think the key point is whether she can be functional in her ‘prescribed’ lifestyle. If she can, I think there’s no need for a great urgency to coming off it. I’m speculating here, but I wager that street addicts can’t be very functional because they need to pay for the dope; spend time and effort to acquire it; and other social and personal contingencies that come with an illegal, ostracized lifestyle. For her, she is, for all purposes, now using heroin in a legal environment.
Where? It provides information about them in passing, but doesn’t promote them.
Infamous UK mass old-lady murderer Dr Harold Shipman used diamorphine (medicinal grade heroin) overdoses to kill his victims. Intestingly, in every news report it was referred to as diamorphine, never heroin. Diamorphine is available in the UK for extreme pain (usually things like terminal cancer), and more rarely, to supply heroin addicts in a damage limitation exercise. But I have heard from one who knows that pharmacutecal diamorphine doesn’t have quite the same buzz as good street heroin. BTW, I’m appalled at Liss’ story of her friend having to die in agony, that’s just so fucked up.
Heroin was first marketed as a painkiller, ironically as a non-addictive alternative to morphine, but it soon found a major use as the main active ingredient in cough mixture. These tinctures became very popular for a few years, before finally it was realised that they weren’t quite as harmless as advertised. But in the heyday of these wonder medicines, the range extended to babies. Most contained tinctures of cannabis or opium, but some had morphine or even heroin. Guaranteed to take away teething pain and stop baby crying. These were available over-the-counter,a nd without prescription.
picunurse’s point about controlled withdrawal is well made. When the will is there, withdrawal isn’t difficult at all, just gradually lower the dose over a set period. For example, at the end of WW2 there were quite a number of wounded RAF pilots recovering from horrible injuries, and many of these were consuming large quantities of prescription heroin while their wounds healed. Once they no longer needed such strong painkillers, they were all able to wean themselves off by gradual withdrawal so they could go back to their respectable pre-war careers and suchlike (the RAF being rather middle class).
Always instructive to hear from Qadgop. Chap.
I wouldn’t want to work there either, but I voted for Vancouver’s last mayor on the strength of his support for safe injection sites. My brother died alone of a heroin overdose in an SRO in the Downtown Eastside. He had been trying to get clean for some time. I know the prognosis for addicts is never something to be unreasonably optimistic about, but I can’t help feeling that his chances of making it through would have been at least somewhat better if there was some oversight for the times he stumbled, too.
My sympathy, Larry. Addiction is a rotten disease with a bad prognosis. Jails, institutions, death, and sometimes recovery. I’ve lost a lot of folks I cared about who wouldn’t/couldn’t stay clean. Every addict needs to hit their personal bottom in order to be able to recover. Sadly, death often intervenes before some folks hit their bottom.
From a public health standpoint, “harm reduction” such as free needles, free drugs, & supervised shooting galleries make a certain amount of sense, as fewer folks die. But fewer folks achieve actual recovery this way too, so there’s the trade-off. Anything that reduces the consequences of using also reduces the impetus to stop using.
In my using days, I’d have grabbed onto someone offering to maintain my addiction for me, with both hands! Now I’m appalled by the idea that I could have spent the last 15 + years my life that way rather than clean and sober.
Nah. Plenty of junkies are very functional. Doesn’t make their lifestyle any more legal. Or healthy. Or less devastating.
The key point is not functionality. At least, in my experience.
Deb, sober since March 4, 1991.
The one thing that was drummed (and I mean drummed) into us in Palliative care is that there is no such thing as a maximum dose of opiate for analgesia. You give the patient what they need to control their pain and try not to depress their breathing while you’re at it.
My grandmother’s uncle was injured in the 1910s, when he pushed a child out of the path of a tram. His leg was crushed, and for the rest of his life he was in agony. As a consequence he took large quantities of morphine, but was about as functional as someone with chronic nerve pain can be: running a shop, getting married, fathering children.
That is, right up until his old doctor died, his new doctor told him that he couldn’t possibly need that much morphine, that he was either an addict or mad, and so refused to prescribe him more. Grandmother’s uncle lasted a week without pain relief, before the pain became too much and he killed himself. During that week the pain confined him to his bed, and my grandmother (who lived with her aunt and uncle) can remember him screaming.
There are worse things than properly administered opiate analgesia. Unrelenting pain, bad enough to make suicide seem preferable, is one of them.
I think you ignored the part where I said that the person in the BBC article is getting pure controlled doses of heroin legally. I was just arguing the point that if she’s functional as a legal junkie, there’s no urgency for abstinence.