Misusing Opioids

“Crisis” or not, opioid overdose is a problem. A lethal one, sometimes.

We’ve used one opioid, opium, for millennia. Others have been developed during my lifetime. They’re all useful: and dangerous if misused.

An “opioid crisis” has been news for a few years now.

But folks have been using — and misusing — drugs for a long time. About two centuries back, nitrous oxide, “laughing gas,” was a party drug before being used as an anesthetic.


“Laughing Gas”


(From Wellcome Library, London, used w/o permission.)
(Inhaling nitrous oxide, 1807.)

There’s always a little nitrous oxide1 (N2O) in Earth’s atmosphere. About a third of it comes from human activity these days.

I’m not sure why I’ve read about the dangers of humanity’s nitrogen dioxide (NO2) pollution — but not the nitrous oxide we’re producing.

My guess is that someone figures nitrogen dioxide is more dangerous than nitrous oxide. Maybe part of the reason is where the gasses come from.

Some nitrogen dioxide comes from bacteria, volcanoes, and lightning. Some nitrous oxide comes from fertilizer and other organic sources. That might make it seem ‘greener.’

On the other hand, nitrous oxide is a greenhouse gas, the fourth most common. The top three are water vapor, carbon dioxide, and methane. Now that I think of it, methane comes from manure, rice fields, and assorted other ‘green’ sources.2

Anyway, Joseph Priestley synthesized the first phlogisticated nitrous air, his name for nitrous oxide, in 1772. I’ve talked about him, and phlogiston, before. (March 24, 2017)

Thomas Beddoes called nitrous oxide “factitious Airs.” He and James Watt developed a machine for making the stuff. They published “Considerations on the Medical Use and on the Production of Factitious Airs” in 1794.

Thomas Beddoes figured tuberculosis and other lung diseases could be treated by inhalation of “factitious airs.” He also developed a “breathing apparatus” that let folks inhale substantial quantities of nitrous oxide.

Nitrous oxide won’t cure tuberculosis, but it makes a dandy anesthetic. It’s called “laughing gas,” since the stuff also makes folks feel really good.

Davy’s Dandy Hangover Cure


(From Wellcome Library, London, used w/o permission.)
(A cartoon from the early 19th century: another reason I don’t miss ‘the good old days.’)

Doctors knew about nitrous oxide’s painkilling properties; or should have, since Humphry Davy had noticed its anesthetic effect while working at the Pneumatic Institution.

He’d published his research in “Researches, chemical and philosophical-chiefly concerning nitrous oxide or dephlogisticated nitrous air, and its respiration.” That was in 1800. But doctors didn’t start using it as an anesthetic for decades.

Meanwhile, folks in the British upper crust were having a blast, using it as a recreational drug. Davy used nitrous oxide as a hangover cure, and became addicted to it.

Avoiding pain makes sense, usually. I’d be concerned about anyone who enjoys it.

Feeling pain is no great virtue, by itself. And there isn’t anything wrong with using painkillers. Within reason. (Catechism of the Catholic Church, 1431, 2279)

The perennial popularity of sickly Saints notwithstanding, there’s nothing particularly virtuous in being ill, either. Or being healthy, for that matter. And that’s another topic, for another post.

Health is a gift from God. Getting and staying healthy is a good idea. Again, within reason. (Catechism, 2288, 2289)

Misusing drugs is not good for my health. It’s also a bad idea. A very bad idea. (Catechism, 2291)

Coleridge and Laudanum

Not all ‘artistic’ folks are physically weak and a bit odd. But Samuel Taylor Coleridge fit that stereotype. He’s the poet who wrote “Kubla Kahn.”

Childhood illnesses left him with chronic ill health. He may have experienced bipolar disorder, but folks didn’t know about that at the time. He got married because 19th century society expected that sort of thing.

He and a friend started planning a pantisocracy in Pennsylvania.

It would have been one of the many 19th century utopian communities. What most of them had in common was the idea that communal living was a good idea.

Coleridge’s pantisocracy didn’t work out, and neither did his marriage. He also learned that laudanum wasn’t as risk-free as folks apparently assumed.

Laudanum is a tincture of opium. Coleridge said that he started using it to deal with chronic swelling in his knees. I figure that makes sense.3

We’ve learned quite a bit since then.


1. “Opioid Crisis”


(From AP, via BBC News, used w/o permission.)

Opioid crisis: The letter that started it all
BBC News (June 3, 2017)

Canadian researchers have traced the origins of the opioid crisis to one letter published almost 40 years ago.

“The letter, which said opioids were not addictive, was published in the New England Journal of Medicine (NEJM) in 1980.

“Dr David Juurlink says the journal’s prestige helped fuel the misguided belief that opioids were safe.

“His research found that the letter was cited more than 600 times, usually to argue that opioids were not addictive.

“On Wednesday, the NEJM published Dr Juurlink’s rebuttal to the 1980 letter, along with his team’s analysis of the number of times the letter was cited by other researchers….”

I’m not sure that a single letter, no matter how influential, is the only factor in what looks like a massive lapse in judgment. I’d like to think that medical research involves more than reading one journal.

“Opioid” is a newish term, and includes opiates, drugs that come from opium, and synthetic drugs that are chemically similar to the stuff. We’ve known about, and used, opium for millennia. Some opioids are quite new.

As I said before, they’re useful — or we can misuse them. Whether they’re ‘good’ or ‘bad’ for us is our decision.

Western academics say that knowledge of opium goes back to about 1500 BC. That’s when someone wrote about it. That bit of writing’s been preserved, so it’s evidence that opium was known at the time.

Fair enough. My academic training was in the Western tradition. I understand the value of written records.

I also think Indian scholars are probably right. Some of them say that oral traditions passed along for millennia were finally written down about 3,500 years back.

Oral Traditions

There’s a similar debate about whether or not Homer really existed. Oral traditions often describe him as a blind Ionian bard.

They don’t add up to a coherent narrative, and probably aren’t ‘accurate’ in the contemporary Western sense.

That’s not proof that Homer didn’t exist.

I figure it’s likely a situation like John Henry in my country’s traditions. Tales of his successful, but fatal, effort to out-perform a steam drill don’t all add up.

A scholar who found a reliable eyewitness thinks the story is, essentially, correct. Another scholar said that can’t be so, since the railroad records for that particular tunnel don’t mention a contest that ended in death.

I’m nearly half-Irish, which helps me believe the oral tradition. Or at least take it seriously. It’s not that we’re gullible or stupid, any more than most folks.

But some of my forebears were near the low end of society’s ladder, not that many generations back. It’s a good place to gain appreciation of distinctions between official records and reality. And that’s yet another topic.

Poppies

We think Papaver somniferum, the opium poppy, is native to lands around the eastern Mediterranean.

We’re not sure, though. Folks were growing it long before we made written records.

Since humans move around, a lot, and trade with others who also travel, stuff gets spread around pretty fast.

By the time we developed writing, we’d learned that poppy seeds are edible. We’d also found medicinal and other uses for the plants.

Latex from opium poppies is about 12% morphine. It’s an effective painkiller.

It’s also addictive and will, in large enough doses, kill a person.4 Nothing unusual about that. Folks have died from drinking too much water. That doesn’t make water, or morphine, bad. It’s another example of why we’re better off if we use our brains.

Folks with different cultures have used opium as a painkiller, in religious practices, and simply for fun.

Partly because I grew up in the 1960s, I don’t recoil in self-righteous horror from drugs I haven’t used. But my background also gives me a lively appreciation for how dangerous such things can be:


2. Prescribed, But Abused


(From Getty Images, via BBC News, used w/o permission.)
(“Abuse of prescription medications such as oxycontin is fuelling a rise in overdoses”
(BBC News))

Drug overdose deaths in the US reach record levels
(December 18, 2015)

More than 47,000 Americans died from drug overdoses in 2014 – the most ever recorded in one year, US officials say.

“The Centers for Disease Control and Prevention (CDC) released a report on Friday that showed overdose deaths jumped 7% from just one year earlier….”

This is year-before-last year’s news. I’d like to say that it was just that one year; or that it wasn’t a real problem.

But I can’t. More accurately, I must not. Embracing truth, all truth, is part of my faith. (Catechism, 142150)

Since I think truth is important, and I’ve been seeing ‘drug overdose’ and ‘opioid epidemic’ in the news, I figured a little research was in order.5

The mortality rate for humans is 100%, no matter what we do. Like someone said, ‘nobody gets out of life alive.’

What kills us varies from one person to another. The Centers for Disease Control says that more Americans die from cardiovascular disease than anything else. That’s followed by assorted diseases, accidents, and suicide.

Death by overdose doesn’t even make the top ten.6

But drug abuse makes some diseases worse, or more likely. I figure it’s involved in quite a few non-overdose deaths. Even when it’s not fatal, I don’t think it makes life better.


3. Dead Counselors


(From Chester County District Attorney, via BBC News, used w/o permission.)
(“Drug paraphernalia was found on a desk in one of the drug counsellors’ bedrooms”
(BBC News)

Addiction counsellors OD at Pennsylvania drug centre
(May 25, 2017)

Two drug counsellors at a US addiction centre have died after overdosing.

“The two live-in mentors were discovered unresponsive at the facility in south-eastern Pennsylvania on Monday.

“Six male recovering addicts who live at the facility discovered the unidentified pair in separate rooms.

“Paramedics pronounced both counsellors dead at the scene, despite residents administering a naloxone injection, which can reverse an overdose if administered immediately….”

Early tests showed heroin and fentanyl in the dead counselors’ bodies. American law lets doctors prescribe fentanyl as a painkiller, but not heroin.

That doesn’t make fentanyl “good” and heroin “evil.” All it means is that American legislators decided fentanyl is okay, but heroin isn’t.

If enough voters get worked up over fentanyl, politicos may outlaw it. Or not, if enough other voters get worked up over keeping the painkiller legal.

I figure fentanyl, heroin, opium, or pretty much anything else, can be used to help — or hurt — folks. How we use materials is up to us. (February 10, 2017)

Realities

There’s plenty of blame to go around.

The two dead counselors should have known better. In a sense, they decided to shorten their lives.

That’s assuming that these were accidental deaths, and there’s no indication otherwise.

I don’t see a point in heaping abuse on them, though. It won’t help them, and I have no idea what led them to this point.

I doubt their motive was putting their health and lives at risk.

Besides, I’m pretty sure that denouncing ‘those sinners’ makes about as much sense as pretending that bad behavior is okay. (June 18, 2017; July 10, 2016)

The odds are pretty good that this isn’t a case of death by prescribed medication. Not entirely. Small bags of heroin bags marked “Superman” and “Danger/Skull & Crossbones” were near the bodies.

I have no idea why the counselors took those drugs. It’s possible that the stress of dealing with recovering addicts became more than they could stand.

That doesn’t mean I blame the recovering addicts.

If stress contributed to these deaths, taking unauthorized painkillers to deal with it is still a bad idea. It would, though, most likely reduce the guilt of the dead counselors.

But ‘I couldn’t help it’ isn’t a good excuse. We’ve got brains, and free will. We’re responsible for our choices. And we’re affected by psychological and social factors which may be out of our control. (Catechism, 17301738, particularly 1735)

Good Health: Within Reason

I haven’t abused illegal drugs. But I have had opportunities to experience something like the physical stress recovering addicts deal with.

I am an addict myself. In a sense. That definitely needs clarification.

About 11 years ago I learned that I had been experiencing clinical depression, major depressive disorder. I’m pretty sure it started when I was 12.

That diagnosis explained a great deal of what I’d been going through over the roughly 43 years leading up to the diagnosis.

The knowledge didn’t sort out my neurochemical glitches, but did make treatment possible. There was just one problem.

The antidepressant which was my best option is addictive.

More precisely, once I started taking it, I would either keep taking it at regular intervals; or experience “discontinuation syndrome.”

That’s a technical term for a phenomenon which is nearly indistinguishable from drug withdrawal.7 I’ve gone through it a few times, while learning that relying on mail deliveries and a bureaucracy is not prudent.

I do not ever want to experience that again. It is very unpleasant.

I don’t think anyone’s ‘to blame.’ The antidepressant is a controlled substance, so the prescription must be re-authorized for every ‘refill.’

The authorization disappeared at the healthcare center, or got lost in the mail, a few times before I started hand-delivering it.

I now drive to a nearby town each month to pick up a legally-required document. This way I can be reasonably certain that it will arrive at the pharmacy. And I get a pleasant drive as a sort of bonus.

Just to make things interesting, the stuff isn’t always available. Sometimes I wait until a shipment arrives and gets processed, and that’s yet again another topic.

On the ‘up’ side, I now have personal experience which gave me some appreciation for the struggles of folks overcoming addictions. And I can, for the first time in decades, use my brain without fighting the controls.

Good health is a gift. Clinical depression is not a healthy condition, so dealing with it makes sense. Within reason.

My faith doesn’t demand medical procedures that are “burdensome, dangerous, extraordinary, or disproportionate to the expected outcome.” (Catechism, 2278)

But taking the prescribed antidepressants isn’t particularly troublesome. I knew the risks involved, and the potential benefits. I do not regret the decision I made, 11 years ago.

More of my take on dealing with reality:


1 Nitrous oxide:

2 A not-even-close-to-complete look at greenhouse gasses, climate change, and all that:

3 Coleridge and laudanum:

4 Poppy products:

5 Some new(ish) painkillers:

6 Getting a grip about drugs and death:

7 Risks and benefits:

About Brian H. Gill

I’m a sixty-something married guy with six kids, four surviving, in a small central Minnesota town. I mostly write and make digital art. I’m only interested in three things: that which exists within the universe; that which exists beyond; and that which might exist.

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6 Responses to Misusing Opioids

  1. Peggy Haslar says:

    Thanks for providing such carefully compiled information, with a the power of personal experience to boot. In my community we’re experiencing an alarming rate of neonatal use and puzzling over how to meet the new resulting needs.

    • Usually I respond with something like ‘my pleasure,’ but I didn’t enjoy researching this as much as I often do. You are, however, quite welcome.

      A very quick look through a ‘neonatal opioid’ Google search showed me a great many references to neonatal withdrawal and issues associated with that situation.

      I feel for the kids, mothers/parents, and all others. Particularly since it seems that prescribed medications are involved in a significant fraction of cases. That doesn’t improve the symptoms, but I can imagine adds a layer or two of ‘what were we *thinking*’ anxiety.

      Thank you for pointing me in that direction, although I don’t know whether or when I’ll follow up on that issue.

      (Folks reading this might want to start with a Wikipedia page on the topic – https://en.wikipedia.org/wiki/Neonatal_withdrawal – It includes a brief overview of the phenomenon, and includes several references for further research.)

  2. Rich Maffeo says:

    very valuable review and well-researched. Thank you.

  3. Thanks for your thorough insights. As always a very engaging piece.

Thanks for taking time to comment!