Posted by bsj on November 29, 2003, at 10:00:58
In reply to Re: Might Opiates in Moderation Fight Depresion?, posted by MysticalMeds on November 28, 2003, at 16:07:53
A short history of the medical use of opiates:
In the late 19th and early 20th centuries, not only could you buy opiates freely, but they were in practically every kind of medication
and remedy available. In a way, the excessive use of opiates in that era paved the way for modern opiophobia in the medical establishment;
opiophobia is a knee-jerk reaction to the very scattershot and disreputable medicine of the past, where heroin, e.g., was used to quiet (sometimes permanently) fussy infants.
Opiates were used to treat some cases of depression up until the 1950s, when the first crude antidepressants became widely used. It was assumed then that ADs could completely replace all other medications for depression--which,
of course, wasn't true, but now doctors had an excuse not to use opiates: they could push the new ADs instead. Then the political and social developments of the next 20 years, Nixon's drug war in particular, would ensure that opiates
would never again see psychiatric use. Even today medical schools drill opiophobia into their students, so that not even pain patients who need the drugs get them in the necessary quantities. It's partly the fault of doctors and partly the fault of agencies like the DEA, who regularly yank the power to prescribe controlled substances from doctors (or threaten to yank; all it
takes is a bit of fear).
The dogma of opiophobia goes something like this: opiates are powerfully addictive drugs that, if used in any quantities for an extended length of
time, will cause addiction and completely destroy the lives of those who take them. The distinction between physical dependence and psychological dependence is rarely taken into account; even though the two are very
different things, it's assumed that one goes hand in hand with the other--i.e., that psychological addiction is inevitable. This is the most dubious
part of the dogma, and flat out false; most chronic pain patients never have problems, e.g. Opiophobia ascribes to opiates powers that they don't have--viz, the power to turn any user into a hopeless slave. Does this happen? Sure.
Is it inevitable, or an excuse not to try opiates for refractory cases of depression? Absolutely not. I'd argue that stimulants are, on the whole,
far more dangerous drugs, yet their use in refractory cases is well established. The exclusion of opiates from the antidepressant arsenal is arbitrary and motivated primarily by political concerns, not medical ones.
(On the subject or mental and physical pain: I can't discern any real qualitative difference between the two; the fact that we tend to think of them as separate things is a legacy of the Western mind-body distinction, going back to Descartes.)