It is the beginning of a hot summer in 1863. The aromas of a three day battle hang in the air. Robert E. Lee is in retreat with what is left of his army. Gen. Lee is heading south from Gettysburg. He orders a portion of his medical staff to stay behind to care for Gen. Longstreet’s dying and wounded men quartered in the Black Horse Tavern and a nearby barn that are now both, a makeshift field hospital. Surgeon, Dr. Simon Baruch is among them. They all are soon to be captured by the Union Forces under the command of Gen. Meade. Until then they care for the wounded and dying. With only minimal understanding of infectious diseases they focus on the triage, anesthesia, amputations and pain control. At their disposal are short supplies of chloroform, some morphine tablets and opium, along with herbal substitutes and a rationed supply of moonshine whiskey. More pain medication would come once captured. Union forces had greater supplies of morphine and opium including syringes for injections. Drugs were liberally used, first with their own wounded and then with the captured Confederates.
Since the development of the hypodermic needle in 1855 the ability to introduce the highly refined opium in the form of the more powerful morphine directly into the blood stream improved the ability of battlefield surgeons to control pain. This advancement in treatment, although beneficial, often resulted in the unintended consequences of a greater degree of chemical dependence, abuse and addiction among the Civil War veterans. Chemical dependence, abuse and addiction continued long after the end of the nation’s war.
Opiate and alcohol addiction in the later 1800s was in epidemic proportions. Shortly after the Civil War morphine kits were readily available and widely distributed into the early twentieth century. Morphine tablets were now less expensive than whiskey and sold in most every general mercantile and drug store. By the turn of the century The Bayer Company took advantage of the recent discovery to be able to refine heroin from morphine. Bayer marketed heroin, a more concentrated opiate, as a cure for coughs, lung consumption and pain. They even promoted it as a cure for morphine addiction and alcoholism. These refinements from opium to morphine to heroin lead to a greater effect on pain control due enhanced concentrations yet a more rapid progression towards addiction. All of these refinements were done with good intentions for the purpose of alleviating pain but with little or no understanding of the chemical dependency risks and the addictive process.
The first recorded use of opium for pain relief was by the Sumerians around 400BC and later by the Egyptians. The form was a crude unrefined gum and paste made from the milky white substance from the dried poppy bulb. The taste was bitter. It was usually mixed with fermented potions and drunk for their medicinal pain killing and euphoric values. The Greeks and Romans also made use of the therapeutic benefits. With the bitter taste and weaker concentration associated with the unrefined opium gum the potential for abuse and addiction although present was greatly reduced. The more the opiate is refined, with each refinement, a greater risk of abuse and addiction occurs regardless of any medicinal therapeutic benefit.
Now we are well into the twenty first century, far from the days of the Civil War and even more removed from the Sumerians and ancient Greeks. What do we have available in our world to alleviate pain? Are we better off now? Let’s take a look.
Our pharmaceutical advancements, which are many, have not only brought us greater refined concentrations of opiate pain relievers, we have learned to synthesize and duplicate what nature once provided those Sumerian and Egyptian healers.
Methadone is a synthetic opioid, first synthesized in late 1930’s Germany prior to World War II in anticipation of a need for pain killers. Germany was then a country gearing up for a European war. They were looking for an effective pain killer with a low potential risk of addiction.
Methadone use began in the United States in 1947 distributed by the Eli Lilly Company. It is now widely prescribed as a pain killer and used for treatment of heroin addiction promoting the harm reduction concept of Methadone Maintenance clinics throughout the United States. As it turns out, Methadone is highly addictive and it is more complicated to detox than heroin. The opiate receptors in the brain although receptive to Methadone do not like synthetics. Sixty people were hospitalized in Colorado due to synthetic marijuana. Many of them on life support. The brain does not like synthetics. Methadone is a simple opioid molecule and it is chemically different than morphine or heroin. However, it does combine with opiate receptors in the brain and therefore, it is effective for pain. The question being, is it worth the risk? According to the Center for Disease Control and Prevention in the year 2009, 15,500 deaths occurred due to the overdose of prescription pain killers, 5,000 of those deaths were caused by Methadone.
That is the number of deaths in just one year. The numbers are on the rise since then.
Other synthetic prescribed pain medications include Darvon, Fentanyl, Demerol, and Talwin. We even have a berry flavored lollipop form of Fentanyl called Actiq. Honest, I am not kidding, opiate candy!
Oh, if only Dr. Simon Baruch had that at Gettysburg.
Some of the semisynthetic and more refined pain medications would be Oxycodone ( OxyContin, Percodan), Hydrocodone ( Lortab, Vicodin), Dilaudid, and Codeine. Codeine being a more refined extract from Morphine. Do we need pain medication? Yes, sometimes we do.
The proper use of prescription pain medications is necessary and has benefited millions of people around the world. It may have been a benefit to you or members of your family. Is it over prescribed, misunderstood and frequently abused? Absolutely-Yes. It is abused by those who prescribe and by those who use. That abuse has extended to addicts and abusers combining prescribed pain medications with other drugs, such as mixing alcohol or benzodiazepines (Valium, Xanax, Klonopin) with pain medications. And yes if you were wondering, alcohol is a drug. The result of this activity is devastating.
According to the National Institute on Drug Abuse in 2009 there were 4.6 million drug related visits to hospital emergency rooms nationwide. Of those 50%, over 2 Million, were due to prescription medications that were taken properly as prescribed. Another 45% were due to the abuse of alcohol and other drugs including prescription pain medications that were abused. The rate of increase over the 5 year period from 2004 to 2009 was 98%. Almost double in 5 years. We are now almost 5 years later and the rate of increase is continuing along with deaths due to the use and abuse of alcohol, prescription medication and other drugs.
Perhaps it is time we did something different. Could we manage pain differently? Not all pain is due to trauma or injury like that experienced at Gettysburg. Not all pain is traumatic and acute requiring pain control intervention. Much of it is chronic in nature. We may be able to reduce, manage and control pain in other ways. Maybe even prevent it before it happens. Not all pain is physical. Much of it is mental pain. Do we need to control every mental or physical malady with a prescribed medication? Is there another way? We are over- medicated and it is getting worse not better.
Our children are over-medicated, our seniors are over-medicated and the way it appears to me some of our political leaders are over-medicated as well. If we have a chemical dependency or addiction, maybe switching to another drug is not the answer. And certainly switching to a drug that is the same or worse than the one you were on, for example Heroin to Methadone or Suboxone, does not sound like recovery.
Let me take a real leap here, maybe you don’t need any medications on a regular basis, or at all. Maybe you just need to make a change in your life. The question I ask all of my patients is what camp do you want to be in? Are you in the camp that seeks out a pill for every problem or are you in the camp that is empowered, taking charge of your own life. What camp do YOU want to be in? How can you make a change that brings you, your family, and our community a better life?
Dr. Michael J. De Vito is a diplomate and is board certified in Addictionology. He is a graduate of Mansfield University of Pennsylvania and Northwestern Health Science University in Minneapolis, Minnesota. He has been an instructor of Medial Ethics, Clinical Pathology, Anatomy and Physiology at the College of Southern Nevada.Dr. De Vito has over 30 years of experience in successfully guiding patients and clients on the path of Recovery Consciousness. He is the founder and program director of NewStart Treatment Center located in Henderson, Nevada. He is presently in private practice helping patients from all parts of the world attain and successfully live a life of recovery from substance abuse and addictive behavior. NewStart Treatment Center utilizes a drug free and natural approach to addiction treatment. www.4anewstart.com Dr. De Vito is the author of Addiction: The Master Keys to Recovery www.AddictionRecoveryKeys.com