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.
1. In 1979, a celebrity doctor and syndicated columnist, Kenneth Walker, who wrote under the pseudonym W. Gifford-Jones, launched a nationwide campaign to legalize heroin (diacetylmorphine) for Canadian patients with terminal cancer.
2. This story showcases how the politics of pain, opioid addiction, and proper end-of-life therapies present enduring challenges in Canadian society, challenges which remain vital today
3. The early 1980s was an historical moment that saw a renewed discussion of opioids in end-of-life care, but also a time in which the prescribing of strong opioids such as oxycodone began to increase in the United States and Canada.
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.
(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.