Which drugs should be available for people nearing the end-of-life and suffering pain? What are the limits of appropriate opioid use in modern medicine and within society? The story of heroin in palliative care during the 1980s remains largely untold, and it’s one thoroughly infused with politics, social values and cultural norms of the time.
I write about this in my forthcoming book and in the newest edition of the Canadian Medical Association Journal. Here are the highlights.
Mental health knowledge and practice was highly contested in the 1960s and 70s. Struggles over homosexuality and radicalism, drug use and replicable drug trials, were part of a unique countercultural moment. These were wild times. Transactional analysis, developed by Eric Berne and Claude Steiner, was also part of this fiercely energetic moment.
In January 2017 Claude Steiner (pictured above), a clinical psychologist, passed away in California. According to his obituary in the San Francisco Chronicle, Steiner’s last words were, ‘Love is the answer’ and ‘I’m so lucky’. He had led a long and full life, and left behind an important legacy in psychology. Steiner was a founder of the Radical Therapist Collective, protested at American Psychiatric Association and American Psychological Association meetings, and edited a collection of Readings in Radical Psychiatry in 1975. Steiner also published a short children’s story called The Warm Fuzzy Tale in 1969 and Games Alcoholics Play in 1970. In 1974, he followed these books up with Scripts People Live, which was a bestseller in the United States. Most importantly, Steiner was influential in developing and popularising transactional analysis.
Steiner was born in France, relocated to Mexico, and then moved to California in 1952 to study physics. But in the aftermath of atomic explosions in Hiroshima and Nagasaki, and seeing how physics was associated with nuclear weapons, he rejected the field. The link to bombs and bomb-making put him off. Transferring to psychology and eventually obtaining his doctorate from the University of Michigan in 1965, he became a close associate of Eric Berne. Set against the backdrop of a topsy-turvy mental health landscape, it is clear that their story had an important impact on psychology – during a unique moment in time – through the creation of transactional analysis.
The full article can be read here
Enjoy. And I’ve written similar work on the 1960s and mental health:
with Social History of Medicine…
and Hidden Persuaders…
Playing soccer has been a hobby/passion/thing to do for the majority of my life.
There’ve been no significant injuries to speak of. Until now.
So let’s talk about ‘the knee’ and pain.
A reckless and ridiculous challenge during my last game resulted in a minor fracture of the knee – and some major sit-on-my-butt time.
(Probably best that I go no further in describing the tackle, lest my blood begins to boil once more.)
So, I’ve got a near future filled with crutches, an immobilizer brace, ice, anti-inflammatory drug. Luckily, the future doesn’t hold surgical interventions! For now.
Treatment for dummies (like me):
The treatment depends on the type of fracture. If you have an open wound with the fracture (I didn’t!), you may need treatment to control bleeding or prevent infection. You may need surgery to:
1) Remove all small fragments of bone
2) Wire the kneecap fragments together, if possible
3) Remove the kneecap if it has shattered
4) Your provider may put your leg in a brace, splint, knee immobilizer, or cast to keep your knee from moving while it heals.
5) Your healthcare provider may prescribe pain medicine.
Pain medication? Well yes. I have been using Extra Strength Advil. And the occasional beer. Sometimes I think I need something stronger. Other times, no.
The National news last night discussed the rise of the opioid crisis and located one of the hot zones in Ohio. The story by Vik Adophia was powerful, well-conceived and executed.
(It’s worth noting that the state of Ohio is suing 5 major drug companies for precipitating the opioid epidemic. The manufacturers of the prescription painkillers are: Purdue Pharma LP, Johnson & Johnson’s Janssen Pharmaceuticals Inc unit, a unit of Endo International Plc, Teva Pharmaceutical Industries Ltd’s Cephalon unit and Allergan Plc.)
Here are some of the top stories related to pain and opioids in the past few days.
After the knee injury, I immediately thought of Christopher Nolan’s Batman trilogy.
So what’s the future hold…
I also thought of Kobe Bryant’s injury history. And as you can see – the Mamba’s knees featured regularly.
Stay tuned for periodic updates.
Today I write for the Saskatoon StarPhoenix and Regina Leader-Post.
The story of cancer patient Ric Richardson, a Métis man from Green Lake, challenges us to think about patient autonomy, medical traditions and Saskatchewan health care.
Just as crucial, his story forces us to reconsider the use and acceptance of traditional Aboriginal knowledge — not only in medicine but in society more broadly.
The full story can be read here:
This past week the UK Government released a Drugs Strategy. Here is some of the reaction to the document, which is available here.
From The Independent:
The Government’s latest policy relaunch aimed at tackling illegal drugs amid soaring death rates has been heavily criticised by campaigners who say it fails to get to grips with the problem.
The UK Drug Strategy 2017 was announced by the Home Office as its flagship initiative to reduce use of illicit substances and improve addiction recovery rates.
Drug misuse has been falling in recent years, figures show. Some 2.7 million 16- to 59-year-olds in England and Wales took illegal drugs in 2015-16, down from 10.5 per cent a decade ago.
However, the latest available figures also reveal deaths are soaring. Some 3,674 drug poisoning deaths involving legal and illegal substances were recorded in 2015, up from 3,346 in 2014 and the most since comparable records began in 1993. Cocaine deaths reached an all-time high in 2015, and deaths involving heroin and/or morphine doubled over three years to reach record levels.
The new Home Office strategy identifies new emergent threats, including drugs previously known as legal highs such as Spice – the drug blamed for causing a “zombie plague” in city centres, which is now causing havoc in the prison system.
Chemsex drugs like crystal meth, GHB/GBL and mephedrone, which are taken before or during sex to boost the experience, are also identified as a growing problem among users who expose themselves to blood-borne infections and viruses, according to the strategy.
It promises “targeted interventions” and close collaboration between sexual health services and other relevant groups, as well as more help for addicts to find houses and jobs and better controls at borders.
However, it immediately came under fire from people and organisations campaigning to reduce the harm caused by drugs.
Some argued that by refusing to countenance any sort of decriminalisation it could never make any serious dent in a trade controlled by organised criminals at an estimated cost to society of £10.7bn a year.
Models in countries such as Portugal were cited, where decriminalising drugs and treating their use as a health issue has reduced consumption, addiction and funding for criminals.
From the Daily Mail:
The Government has ‘no intention’ of making cannabis legal in the UK, officials have announced in a new blitz on drugs.
Despite a growing body of evidence showing the world’s favourite recreational drug to be safe, possession will remain punishable with jail.
Experts have slammed the Home Office’s controversial decision, describing it as a ‘missed opportunity’ to legalise the herb.
But ministers pointed to various studies that have shown cannabis to be detrimental to human health, with significant links to schizophrenia.
Such worrying associations have existed for decades, and were responsible the decision to reclassify the drug to a Class B nine years ago.
In recent years, Spain, South Africa, Uruguay and several states in the US have made cannabis legal for recreational use.
Pressure has been increasing on the UK to follow suit and update its drug policy, with many citing weed’s medicinal properties.
But Ian Hamilton, a drug researcher based at York University, told MailOnline the UK’s updated stance shows it’s falling behind.
He said: ‘The government has missed an opportunity to provide less harmful ways of people accessing and using cannabis.
‘The UK is falling behind many other countries who are adopting progressive policies towards drug use.
‘These countries have embraced the evidence and recognise that punishing people who use drugs does not improve their health and adds to social inequality.’
Cannabis is currently a Class B drug in the UK, and anyone found in possession can face up to five years in prison.
From The Guardian:
The wait is finally over for those of us working in the drug policy and drug treatment sectors. The Home Office published its new drug strategy on Friday, two years after its planned deadline in 2015. Sadly, however, this is not a case of good things coming to those who wait. For a 50-page document, there’s very little in the new strategy that can earn it its name.
Against a backdrop of increasing policy innovation in the wider world, the main aims of this strategy are largely unchanged from the previous 2010 version. There’s still a focus on recovery, rather than harm reduction. A continued commitment to tackling the problems caused by drugs through the criminal justice system, rather than through the health system. A point blank refusal to consider decriminalisation, or any reforms to the Misuse of Drugs Act.
Worse, what good initiatives there are in the strategy – and there are some – seem to have been dreamed up by minds unfettered by the reality of public health, criminal justice and policing systems squeezed to breaking point.
Andy Burnham, giving the keynote address at a conference in Manchester last week aimed at developing a more connected response to the city’s rising spice epidemic, echoed the thoughts of many in these fields: “Where is the money? Our frontline services are being overwhelmed. I didn’t hear any mention of any extra funding in the radio this morning. It seems quite hollow, what was being said.”
First then, for the good news. Greater efforts are going to be made to provide effective, evidence-based drug prevention and education to young people. Gone are the school visits from the trite ex-user or the finger-wagging police officer: effective resilience training is in.
Prisoners, too, are to be given more help into recovery, their progress monitored closely. Far clearer and more explicit guidelines have been given on the value of opioid maintenance treatments, which allow so many people with opioid dependence to live their lives, and crucially, prevent overdoses.
The people who slip through the cracks of dual diagnosis from mental health and problem substance use are to be better catered for, rather than shunted between services reluctant to take on complex and demanding cases.
Of the rather pedestrian reforms, these are the brightest spots. However, with cuts to local authority public health budgets totalling £85m this year, and ringfenced drug treatment budgets expected to be cut by £22m, it’s anyone’s guess as to where the money will come from for such initiatives. More likely that these reductions will further eat into essential services such as needle exchanges, and hamper local authorities’ ability to properly assess the performance of the services they commission.
(Read the whole article using the link above)
From The Huffington Post:
The Government’s new drugs strategy has been condemned as “business for usual” for failing to embrace radical solutions to soaring drug deaths.
The Home Office announced its long-awaited strategy that pledges to crack down on drug dealers and cut demand by expanding education on drugs and alcohol and expanding the Prevention Information Service.
Writing on HuffPost UK, Home Secretary Amber Rudd said the plan would target “unscrupulous drug dealers” while trying to do more to “protect the vulnerable – to prevent them falling into the cycle of drug abuse and to help them turn their lives around”.
While the new strategy does call a rise in drug deaths “dramatic and tragic”, it was condemned as “business as usual” by one advocate for change.
Niamh Eastwood, executive director of drug law experts Release, told HuffPost UK the strategy should have mooted ending criminal punishment for possession, following the lead of other countries.
If you have other stories and media accounts that you think should be added, get in touch.
Check out my new piece with Hidden Persuaders. Check it out and get transported back to Miami, 1969!
Health and fitness trends evolve. Technology and imperatives in business force change. Consumers in health want fresh ideas and products. From Tae Boe to Thighmasters. From Bowflex to Bodyblade and belt massagers. Yoga is no different.
Yoga is becoming increasingly popular in the United States. About 37 million Americans practiced yoga at the beginning of 2016 and more than 80 million Americans were likely to try yoga at some point in the year, according to a study in Yoga Journal.
With all these potential pupils, teachers innovate. They employ new techniques and tricks. They use props and blend practices. Here are some examples in 2017.
- Yoga Retreat/Vacation
- Mobile Yoga (as in phones and apps)
- Live Music Yoga
- Yoga Therapy
- Acrobatic Yoga
Say what you will about these types of yoga, they’re coming your way. (That is, if they haven’t already!)
Yoga Retreats & Vacations
From the Guardian newspaper. “You can’t move for downward dog opportunities these days. The explosion of yoga in western countries means there’s a studio on every other street and such a variety of styles and options, that choosing a holiday or retreat can be overwhelming. So where to start? It makes sense to try a weekend away before committing to a whole week. One possibility is to choose a teacher you know or like the sound of and see if they’re running anything that suits. Or you could pick a venue you fancy and see what teachers are hosting holidays there. Think about what you want too – some combine yoga with other activities (maybe good for those with non-yogi partners), some are vegan, some don’t ban booze – it’s always worth asking before you book.”
Here, mobile yoga studio have modified so that the “studio” travels to where the people may be…at work, shopping, at play, in the community. Yoga apps brings teachers right to your home!
From the New York Times: “Soul Stretch Mobile Yoga is a novel concept to the Cleveland area,” explains Rose Sabin, co-owner of the company with her daughter-in-law, Natalie Sabin. The mobile studio concept has worked well in other cities, “like Los Angeles, New York, Chicago” according to Sabin, “but this is Cleveland’s first mobile yoga studio.” Sabin’s goal for the company is two-fold: first, to bring yoga to the people by making it accessible and secondly, to help promote local businesses by bringing the unique offering of yoga class to a community business. As an advertising agency owner, Sabin understands all aspects of running a small business like certifications, insurance and marketing. She would like to help other business owners by allowing them to offer her company’s services and “expose more people to the beautiful, healing therapy of yoga.”
Recommended apps, courtesy of Healthline:
- Yoga.com Studio
- Pocket Yoga
- Global Yoga Academy
- Yoga Studio
- Daily Yoga
- Fitstar Yoga
- 5 Minute Yoga
Live Music Yoga
Pretty straightforward. Here’s an example.
Yoga Therapy, according to the British Council for Yoga Therapy, is the use of Yoga where there is a specific health need or needs. It is framed this way:
“Yoga Therapy uses the tools that you would find in many Yoga classes; postures, working with the breath, meditation, awareness of the body and/or mind, relaxation, and these are directed to the needs and ability of the person concerned. The aim is to promote good health for the person as a whole – the emphasis of this work may be towards the body, the mind, the emotions or a combination of these. A health problem may be primarily in one of these aspects, for example, back pain caused by poor posture. Yoga Therapy would then focus on working with the body and Yoga postures. If the back pain is exacerbated by stress, then including Yoga to help calm the mind, for example breathing techniques, will be very useful too. Our health is a dynamic combination of body and mind. Long term physical conditions are commmonly associated with depression and a variety of feelings – sadness, loss, frustration, anger. Our emotional health affects our physical health too, although this is difficult to quantify. Yoga can bring us awareness of the body and mind; and more understanding of how to help the body, emotions or patterns of thinking and provides a practical approach to developing a positive state of health.”
For Georg Feuerstein in the Huffington Post, “Yoga therapy is of modern coinage and represents a first effort to integrate traditional yogic concepts and techniques with Western medical and psychological knowledge.”
According to the official website of AcroYoga, “it is a beautiful blend of ‘the wisdom of yoga, the dynamic power of acrobatics and the loving kindness of Thai massage’.” It was founded by Jenny Sauer-Klein and Jason Nemer in 2003. The 3 main aspects of this form of yoga are trust, playfulness and a sense of community. Acro Yoga constitutes 3 elements: the Solar Acrobatic Practice, the Lunar Healing Arts, and the Yogic Practices.
There are several benefits as described on Stylecraze.com, including:
- It develops amazing core strength.
- Acro yoga has all the benefits of yoga and the healing properties of Thai massage.
- It is improves balance, flexibility and coordination of the body.
- It gives better control over one’s body.
- It builds relationships and strengthens them. Acro yoga is based on trust and dependability of two people on each other. It helps in building strong partnerships.
- It is a great way to workout with your spouse. It is a super romantic form of exercise. It brings people together.
What does 2018 hold?
That makes a lot of sense. Have you seen a change in which styles of yoga have been more popular over the years? I can’t necessarily track it through the decades, but I would say that vinyasa is more of a recent trend. Historically I think it was more Iyengar, more of that traditional track. What I’m seeing rising in popularity now is definitely the more restorative classes, like Yin. Part of that is because people are recognizing the greater benefits. There’s been a lot of research on what restorative can do for you beyond just stress relief. I’m also seeing a rise in the popularity of Kundalini...I think it’s really interesting and not necessarily what I would have anticipated.
Maybe a reaction to the it’s-all-about-sweat set. How do you feel about the crazy amount of commercialization around yoga in the past few years? Is it good or bad for yoga? Honestly, we get overwhelmed by the number of new products out there, and it’s hard to determine what’s good and what’s worth your dollars. And what’s so awesome about yoga is you really don’t need much to do it. It’s “have mat, will practice” pretty much. All the other stuff can be great and fun but is maybe not necessary. We hear all different opinions—some people really want to know what the best new yoga pant is and then some don’t, they just want to stick to the practice and be more traditional about it. I think it probably does get more people on the mat, though, and that’s a good thing.
A Call for Papers.
Socioeconomic factors and mental health: past and present
Editors: Professor Matthew Smith and Dr Lucas Richert (University of Strathclyde, UK)
This article collection will examine how the relationship between socioeconomic factors and mental health has been and is understood in an array of different places and periods. Although much of the focus of current mental health research and clinical practice is on the neurological aspects of mental illness and psychopharmacological treatment, historical research demonstrates that a wide range of factors — from vitamin deficiencies such as pellagra, and infections such as syphilis to traumatic life events — have contributed to the onset and exacerbation of mental health problems. Among all these factors, one looms largest: socioeconomic status. On the one hand, socioeconomic inequality has been long recognised as a potential cause of mental illness, as the history of mental hygiene and social psychiatry during much of the twentieth century demonstrates. On the other hand, however, the mentally ill have also historically faced much socioeconomic hardship; today, a high proportion of the homeless and incarcerated in many countries suffer from mental illness.
By exploring this topic across time and place, this collection aims to provide a historical context for today’s mental health crisis, and also to inform current mental health policy, especially attempts to prevent or alleviate mental illness through social change.
Insights on a broad spectrum of themes are welcomed, including, but not restricted to
- Homelessness and mental illness;
- Social psychiatry and mental hygiene;
- Community mental health;
- Forensic psychiatry;
- Race and mental health;
- Psychiatry and various economic/political systems (e.g., communism, socialism, capitalism);
- Socioeconomic factors and child mental health;
- How health professionals deal with poverty and mental health;
- Social policy and mental health;
- Social activism and mental health.
This is a rolling article collection and as such proposals and submissions will be welcome throughout 2017. However, full submissions received by November 1 will be considered for publication as part of the collection’s formal launch in 2018.
Please do think about submitting.
From the NIH. A post by Professor Erika Dyck on the history of LSD.
Circulating Now welcomes guest blogger Erika Dyck, PhD, Professor and Canada Research Chair in the History of Medicine at the University of Saskatchewan. Today, Dr. Dyck shares some insights on a recently digitized film in the Library’s collection highlighted in our Medical Movies on the Web project.
For Rebels, it’s a Kick…
It’s the late 1960s. Teenagers, a hip voice clues us in, are always looking for kicks, and today’s teens express themselves with cool fashions, groovy hairstyles, and kooky pranks. Not so long ago, our narrator played the character of “Plato,” a troubled teenager, in the 1955 classic Rebel Without a Cause. In that film, Plato idolizes the reckless machismo of young Jim Stark (played by James Dean). In an epic display of bravado, Jim and another boy play a game of “chickie run” in which they drive their cars in parallel directly toward a cliff. Jim leaps…
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