Do No Harm: Initial Prescription Details Influence Chance of Opiate Dependence

By Terry Gotham

One of the biggest problems with writing about the War on Drugs is the almost exclusive focus on problems. There’s this myth that drug use is a combination between a ratchet & Russian roulette. It’s going to keep getting worse, and it gets harder and harder to “not be addicted” the longer you do it. This continued narrative is believed widely (just ask your family at Easter dinner), while being only lightly supported with evidence. Harm reduction & physician/client education is surprisingly effective at mitigating a lot of the factors that contribute to this “it’s probably going to kill you” problem, but outside of needle exchange/safe injection sites & drinking water while partying, complex harm reduction ideas rarely make it into non-academic circles. So, I’m going to start talking about constructive, modern ideas and research that have been either theorized, published or put into practice, about how to fight this deluge.

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Cannabis and Kratom: A Light in the Opiate Dark

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Analysis by Terry Gotham

With the country currently gripped in fear that ACA will be repealed, I’ve started to ponder what options will be left for Americans in the throes of physical dependency if the cuts to medical/addiction funding are as deep as the ones currently being floated. While some proponents of the 21st Century Cures Act note that there’s been a scheduled $1 billion increase in funding for treatment, a repeal would remove at least $5.5 billion in funding to almost 3 million people suffering from substance use disorders. As dozens of states grapple with ever-increasing rates of opiate addiction and overdose, states that have legalized cannabis have discovered something startling.

A study published in the Journal of Pain by a trio of researchers out of the University of Michigan documents a reduction in opiate consumption in Chronic Pain patients who use cannabis. Specifically, medical cannabis uses was associated with a 64% reduction in opioid use. Additionally, 45% of the patients (118 out of the 244 sampled), reported reduced side effect frequency & intensity. In states that have medical marijuana available for their citizens, drivers between the age of 21 and 40 who were killed driving accidents tested positive for opiates significantly less often than drivers of the same age in states that didn’t have medical marijuana available. For example, Montana saw a 1.7% reduction in the number of drivers who tested positive for opioids after their MMJ laws went into effect. And that’s just numbers associated with people behind the wheel. When we evaluate the effect of cannabis consumption on opiate overdoses, the evidence becomes even more compelling.

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Louisa May Alcott: Breadwinner, Frustrated Creative and Opiate Addict

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by Terry Gotham

While I was never that big of a Louisa May Alcott fan, her impact on American literature cannot be denied. Alcott is an adored and fiercely protected author, in no small part because of just how impeccably written and potentially life-changing Little Women can be.  Her eight YA novels have remained in print continuously for the 140 years since they were written. There are two anime adaptations of Little Women, plus half a dozen other adaptations. Her creative output is a fundamental piece of American literature. Today is her 185th birthday, so I wanted to tell you a story about her. You probably didn’t know she smoked hashish and used opium for most of her life to deal with the side effects of mercurous chloride to treat typhoid pneumonia, which is believed to have eventually killed her (though an alternative diagnosis of Lupus was suggested in 2007).

Previously, I was delighted to dismantle the myth that the Civil War created a flood of heroin addict veterans. However, that doesn’t mean everyone managed to escape the clutches of substance abuse. Nurses, doctors and surgeons were far more exposed to the dangers of these substances than the Union soldier who only saw the inside of a field hospital once during his service. Repeated use of alcohol in the form of whiskey and opium in the form of laudanum, morphine, and heroin to treat hundreds of soldiers a week, in addition to essentially zero oversight when it came to use was a one-two punch that created a tempting proposition for those who tended to the wounded on both sides. There are a number of isolated reports, documenting the odd doctor or surgeon who got a little too sauced at work, or needed to be relieved of his duties because he was incapacitated. This implies that there could have been more of these medical practitioners who didn’t get caught, but still ended up using to cope.

Louisa May Alcott, one of the most influential and beloved American writers of the 19th Century, was one of these medical practitioners. She worked under Dorothea Dix who administrated military hospitals as a nurse.   Before leaving for the Civil War, she’d already assumed her station at the head of the household. Her father, one of the pre-eminent thinkers of their day, couldn’t keep it together for long enough to keep them out of poverty. When she left for the Civil War, her father was reported to have said he was “sending his only son to war.”

It was during the Battle of Fredricksburg that she contracted typhoid pneumonia, an ailment that would alter her life forever. The prescription for typhoid was calomel, and to ease the side effects of literally consuming mercury every day, she started using opium, in the form of morphine & laudanum. She didn’t enter into this habit by accident. She was a very smart lady and knew the potential dangers in consuming it daily. Alcott assisted Catherine Beecher in writing The American Woman’s Home in 1869, a year after Little Women was published, in which she stated:

“The use of opium, especially by women, is usually caused by at first by medical prescriptions containing it. All that has been stated as to the effect of alcohol in the brain is true of opium; while to break a habit thus is almost hopeless. Every woman who takes or who administers this drug, is dealing as with poisoned arrows, whose wounds are without cure.”
~Alcott & Beecher, The American Women’s Home (1849), revision of A Treatise on Domestic Economy (1841)

But a little thing like typhoid pneumonia & a daily opiate habit didn’t stop her. She built herself into the powerhouse of an author by sheer force of will. Realizing that her success and financial stability was depending on her career as a writer, Alcott built herself and her writing into a brand that we remember to this day. While she had made money previously from writing pulp fiction, this was light years away in propriety from Little Women and the branding and recognition that followed. The pulp was published anonymously or under a man’s name (A.M. Bernard) for similar reasons to why women writers today publish using a man’s name.

By 1870, she had grown so dependent on opium that she no longer expected to be able to sleep without it, as she described at the end of this letter to her father:

Our hotel is on the boulevard, and the trees which are in really good care thanks to http://www.treeservicekingsport.com, also the foundations, and fine carriages make our windows very tempting.. We popped into bed early; and my bones are so much better that I slept without any opium or anything, a feat I have not performed for some time.
~Louisa May Alcott to her father, Hotel D’Universe, Tours, June 17,1870

As discussed in the Seattle Pi article that I’ve cited a few times, it’s important for stories like this to be told. Not because I think famous people should be knocked down off their pedestal, but just the opposite. We treat substance use/abuse as almost integral to the creative process, especially when it comes to strong drink and writing. This seems to be heavily amplified in men while minimized in women. The idea that alcoholism is this noble part of the developing male writing process has been so deeply embedded in the work that I have friends who honestly didn’t pursue significant study in writing because they were Irish and didn’t want to fall in love with Jameson. This is going on while we eulogize female writers in the exact opposite way, discussing them as pure or without stain, objectifying them in hugely problematic ways. Then, when someone like Amy Winehouse, Billie Holiday or Janis Joplin struggle and die from drugs, we pretend there was nothing we could do and that it just “happened again.” That needs to stop. As a dear friend reminds me, we celebrate drug use in men and totally ignore it in women.

Creative women are no different than creative men and their processes should be laid bare for all to see, scars and stumbles included. Louisa May Alcott probably pursued her habit away from her family or those who could help her. Given her status as the household’s main income generator, I think it’s easy to see her habit in line with the alcoholism of Don Draper, or the cocaine usage of a street dealer. They use because they have to, in order to provide for the people they love. Louisa May Alcott was able to produce Little Women & Perilous Play, a story about hash, in the same year. That’s nothing if not professional. She inspired generations of women to be better than the brand she created. Which is the point of art in the first place. She may not personally be this amazing protagonist hero that she write about, but in striving to be so, even if it’s only to feed her family and take care of your idealist, lazy ass family, she created the possibility for those who looked up to her to become exactly that. As a biographer of hers said on NPR: “You don’t grow up to walk two steps behind your husband when you’ve met Jo March.”