Serious question: pain-killers in warfare and civilian life

[Rath Darkblade]

I'm currently reading "A is for Arsenic", a book about the poisons that Agatha Christie uses in her books. It describes not only the poisons and their effects, but also famous cases, how the poisons work, any antidotes etc. It's a fascinating book - well worth reading.

I've just come up to Morphine, and the author describes how morphine is extracted from poppy plants and the various alkaloids and compounds that used to be made or extracted from morphine: laudanum (morphine soaked in alcohol), codeine (a more moderate and less addictive form of morphine), heroin (a stronger pain-killer but much more addictive), etc. and what happened to people when they went "cold turkey". The symptoms of a "cold turkey" cure are deeply distressing and unpleasant, true, but after weeks or months of treatment, it's possible to lose the addiction.

Here's my question: the author, Kathryn Harkup (who is also a chemist) gives as an example the fact that 90% of those American soldiers who used heroin in the Vietnam War, and later abstained from it, made a full recovery. Don't get me wrong: I'm not passing judgement in any way. War makes people do things that they wouldn't normally do in "everyday life".

I assume, though, that no army (American or otherwise) uses heroin as a pain-killer. But being shot must be excruciating. What would the medical corps use now for pain relief? Just wondering.

I also know that codeine is now banned in civilian life, because of its addictive purposes. Does the army use codeine? Is there anything available (legally, of course) to civilians, other than paracetamol (aka acetaminophen) or ibuprofen?

[Tawmis]

Here's my question: the author, Kathryn Harkup (who is also a chemist) gives as an example the fact that 90% of those American soldiers who used heroin in the Vietnam War, and later abstained from it, made a full recovery. Don't get me wrong: I'm not passing judgement in any way. War makes people do things that they wouldn't normally do in "everyday life".
I assume, though, that no army (American or otherwise) uses heroin as a pain-killer. But being shot must be excruciating. What would the medical corps use now for pain relief? Just wondering.
I also know that codeine is now banned in civilian life, because of its addictive purposes. Does the army use codeine? Is there anything available (legally, of course) to civilians, other than paracetamol (aka acetaminophen) or ibuprofen?

Well Heroin is a different chemical mixture than morphine.
I do believe that medics in the army can use morphine (in hospital camps and such).
I am not 100% certain of that, only being a Navy Brat, and not actually in the military itself.
But none would use heroin for any form of "medical" purpose.

As for pain relief, over the counter, no - it's pretty much pharmaceutical or your standard "pain relief" medication (like ibuprofen).
There are cases, where some people are "at home care" where they may have a "at home nurse" tending to them that has a morphine drip, however, I am sure.

[DeadPoolX]

Armies of the past (and by past, I mean even as recent as the world wars and Vietnam) have used all sorts of substances, ranging from from methamphetamine to nicotine to stave off hunger, drowsiness, and pain.

As far as I know, no, they wouldn't use heroin, but hospitals have used cocaine in very limited and highly controlled dosages. That's the key right there: any highly addictive substance is okay to use on a short-term basis and when controlled and monitored by healthcare workers. Problems set in when people have to control themselves and inevitably don't do that well or at all.

My dad's a physician (he's been a neurologist for over 40 years) and I remember him telling me that when doctors tell patients how much of whatever medication they can take, they always lower the amount. In other words, if you could safely take 10 pills a day of "whatever," your doctor will likely tell you anything from five to eight pills of "whatever." Why? Because it's well-known that patients show very little self-control and end up taking more than they should.

A lot of people have some very weird ideas about medication, probably some of which come from Hollywood. I lose my shit every time I see someone decide they're "better off" without psychiatric medication for schizophrenia or dump the entire pill bottle's contents into their hand and take it all at once, or toss away their inhaler because they're "suddenly better by sheer force of will." It's all nonsense, but it gives people — many of whom apparently have all the common sense of a Darwin award-winner — bad ideas and then they get themselves into medical trouble.

[notbobsmith]

I've just come up to Morphine, and the author describes how morphine is extracted from poppy plants and the various alkaloids and compounds that used to be made or extracted from morphine: laudanum (morphine soaked in alcohol), codeine (a more moderate and less addictive form of morphine), heroin (a stronger pain-killer but much more addictive), etc. and what happened to people when they went "cold turkey". The symptoms of a "cold turkey" cure are deeply distressing and unpleasant, true, but after weeks or months of treatment, it's possible to lose the addiction.

Here's my question: the author, Kathryn Harkup (who is also a chemist) gives as an example the fact that 90% of those American soldiers who used heroin in the Vietnam War, and later abstained from it, made a full recovery. Don't get me wrong: I'm not passing judgement in any way. War makes people do things that they wouldn't normally do in "everyday life".

There is physical and psychological addiction. Physical addiction is what gives the withdrawal symptoms. The body has grown accustomed to the drug and will react when it is no longer used. Psychological addiction is the person's "need" for the effect of the drug. The symptoms of physical addiction can be overcome, but psychological addiction is more difficult. There be a correlation between addiction and mental illness. Drug use may be a form of self-medication. For example, alcoholism may be a manifestation of clinical depression. As for the 90% statistic, I can't say if that is accurate or not.

I assume, though, that no army (American or otherwise) uses heroin as a pain-killer. But being shot must be excruciating. What would the medical corps use now for pain relief? Just wondering.

I also know that codeine is now banned in civilian life, because of its addictive purposes. Does the army use codeine? Is there anything available (legally, of course) to civilians, other than paracetamol (aka acetaminophen) or ibuprofen?

I'm not sure what the military uses now. I know during WWII and for some time after they used morphine in the field. Morphine is still in use. Codeine is also still in use for treatment of moderate pain. Acetaminophen, ibuprofen, and aspirin are all over the counter pain relievers. There are much stronger pain relievers, usually opioids. For example, Oxycodone which is also known as oxycontin or is paired with another drug like in percocet (with acetominophen). Fentanyl is another one. In the US, there has been allegations of over-prescription leading to an opioid epidemic and pharmaceutical companies have been sued over this. They are very strong pain relievers and not necessary for moderate pain. That said, there are patients for which there is simply no other alternative.

[DeadPoolX]

I think we also need to point out that medications such as naproxen (Aleve), ibuprofen (Advil), and acetylsalicylic acid (Aspirin) aren't just painkillers, they belong to a class of drugs called NSAIDs (non-steroidal anti-inflammatory drugs). These can help with pain management, but in addition they reduce inflammation.

The "non-steroidal" part is because NSAIDs aren't steroids, and aside from NSAIDs, only steroids can reduce or eliminate inflammation. NSAIDs don't work as well as steroids, but NSAIDs have fewer side-effects and risks compared to long-term steroid use. That said, NSAIDs can have side-effects, some of them potentially quite serious, but they don't suppress the body's immune system like steroids do.

[Rath Darkblade]

Armies of the past (and by past, I mean even as recent as the world wars and Vietnam) have used all sorts of substances, ranging from methamphetamine to nicotine to stave off hunger, drowsiness, and pain.

Alcohol too, I'm sure? Most armies of the past have used alcohol to numb pain and stave off hunger, right? I remember reading of one British "army" (I use the word advisedly, as they had malfunctioning weapons, no training, and hardly even food) who tried to invade ... *looks it up* ah, Santo Domingo. This was back in the 1650s, under Cromwell's New Model Army. I can't imagine how they could assault anything without weapons, food, or even water. Apparently, during the withdrawal, some of the men came across a wine cellar, scoffed the lot, and were butchered by the Spanish. I wouldn't be surprised at this; the whole operation seems to have been a fiasco from start to finish.

As far as I know, no, they wouldn't use heroin, but hospitals have used cocaine in very limited and highly controlled dosages. That's the key right there: any highly addictive substance is okay to use on a short-term basis and when controlled and monitored by healthcare workers. Problems set in when people have to control themselves and inevitably don't do that well or at all.

Hmm. Would there be problems if soldiers used heroin, but only -- as you say -- in limited and controlled doses, and when monitored by healthcare workers?

A lot of people have some very weird ideas about medication, probably some of which come from Hollywood. I lose my shit every time I see someone decide they're "better off" without psychiatric medication for schizophrenia or dump the entire pill bottle's contents into their hand and take it all at once, or toss away their inhaler because they're "suddenly better by sheer force of will." It's all nonsense, but it gives people — many of whom apparently have all the common sense of a Darwin award-winner — bad ideas and then they get themselves into medical trouble.

Sigh. The "sheer force of will" business is very depressing. It reminds me of Hitler's excesses (e.g. willing Operation Barbarossa to succeed and ignoring facts on the ground), or Mussolini's (e.g. willing his almost non-existent air force to bomb London back to the stone age, or giving his soldiers a pistol and six rounds each and telling them to invade Greece because "the Greeks will run away"). It would be almost farcical if it wasn't so serious.

Hollywood films are sheer fantasy. They set out to show what life should be like, not what it's really like. The trouble starts when people believe Hollywood.

As for taking the entire pill bottle at once, or tossing away your inhaler ... sigh. That's a really good way to make yourself sick, at least. In cases like this, do the families try to sue the doctor? I wouldn't have thought they'd have a leg to stand on.

[DeadPoolX]

Alcohol too, I'm sure? Most armies of the past have used alcohol to numb pain and stave off hunger, right?

While alcohol can numb pain, it doesn't do much for hunger. In fact, drinking alcohol can increase your urge to eat fatty foods.

Hmm. Would there be problems if soldiers used heroin, but only -- as you say -- in limited and controlled doses, and when monitored by healthcare workers?

Honestly, I don't know when it comes to heroin.

Sigh. The "sheer force of will" business is very depressing. It reminds me of Hitler's excesses (e.g. willing Operation Barbarossa to succeed and ignoring facts on the ground), or Mussolini's (e.g. willing his almost non-existent air force to bomb London back to the stone age, or giving his soldiers a pistol and six rounds each and telling them to invade Greece because "the Greeks will run away"). It would be almost farcical if it wasn't so serious.

Yeah, for some reason people like to believe in anything EXCEPT science, probably because they feel it gives them a sense of agency without needing to rely on professionals. The funny thing is that many of these same people turn to "experts" who should in no way be dispensing medical advice.

Hollywood films are sheer fantasy. They set out to show what life should be like, not what it's really like. The trouble starts when people believe Hollywood.

The worst are movies and TV shows that take place in the real world because despite being inaccurate or unrealistic, they give the appearance of being realistic. Sure, you could do a little research (which is easy to do nowadays) to find out, but that assumes you even question the premise, which a lot of people don't do and instead believe whatever they see or hear.

Unfortunately, a large segment of humanity prefers to believe in anecdotal evidence by way of personal experiences or stories over actual scientific proof and data. I understand there's roots in humanity for this (after all, our ancestors told stories by the campfire), but to actively prefer unverified self-reported information over data that can be replicated is a problem.

As for taking the entire pill bottle at once, or tossing away your inhaler ... sigh. That's a really good way to make yourself sick, at least. In cases like this, do the families try to sue the doctor? I wouldn't have thought they'd have a leg to stand on.

Most wouldn't, but I bet some would. These cases would be thrown out, but it could still negatively affect a physician's malpractice insurance rates.

[Tawmis]

Alcohol too, I'm sure? Most armies of the past have used alcohol to numb pain and stave off hunger, right? I remember reading of one British "army" (I use the word advisedly, as they had malfunctioning weapons, no training, and hardly even food) who tried to invade ... *looks it up* ah, Santo Domingo. This was back in the 1650s, under Cromwell's New Model Army. I can't imagine how they could assault anything without weapons, food, or even water. Apparently, during the withdrawal, some of the men came across a wine cellar, scoffed the lot, and were butchered by the Spanish. I wouldn't be surprised at this; the whole operation seems to have been a fiasco from start to finish.

Well, alcohol was used typically to numb pain for wounded soldiers, only on a quick basis really. Like if they were going into surgery and had nothing else.
It was also used to pour onto wounds to stave off infection(s).

Hmm. Would there be problems if soldiers used heroin, but only -- as you say -- in limited and controlled doses, and when monitored by healthcare workers?

I don't think Heroin ever had any logical medical use, because even in small doses is causes a "euphoric" high. Which isn't helpful in any situation.

[Rath Darkblade]

Oh, I'm sure heroin was used for medical purposes -- but a long, long time ago (possibly in the American Civil War, or later in the 19th century). I'm guessing that doctors figured out that if a little morphine or laudanum (morphine and alcohol mixed together) promoted sleep and healing, then heroin -- which also made you ignore pain and feel heroic (hence the name) must be even better, right?

Of course, that was before doctors realised how addictive heroin was.

On the plus side, it can make people feel drowsy, and their heart rate and breathing slow down. So, if a patient is suffering from tachypnea (fast, shallow breaths, e.g. from a lung disease) or hyperventilation (taking rapid, deep breaths), then heroin logically can counteract that. It can also help tachycardia (i.e. your heart beating too fast).

On the minus side, of course, is how dangerous heroin is -- especially in the long run.

So I suppose my question is this: if it was done under strict monitoring by healthcare professionals, and in controlled doses, could there be problems? I assume so. (There have been some complaints here in Australia about "safe injection rooms" for drug addicts. If healthcare professionals helped these addicts with controlled doses, that would be better than the addicts taking drugs in some alley somewhere. So I'm not sure what the problem is).

[Tawmis]

Oh, I'm sure heroin was used for medical purposes -- but a long, long time ago (possibly in the American Civil War, or later in the 19th century). I'm guessing that doctors figured out that if a little morphine or laudanum (morphine and alcohol mixed together) promoted sleep and healing, then heroin -- which also made you ignore pain and feel heroic (hence the name) must be even better, right?

It wasn't used during the American Civil War (Apr 12, 1861 – Apr 9, 1865) because it hadn't been "invented yet."

Around 1805, the French pharmacist Friedrich Sertürner discovered how to isolate one of opium’s active ingredients: morphine. Morphine was used widely to treat pain and to cure opium addiction before its own addictive properties were known. Morphine saw use in the United States during the American Civil War when it was used to manage pain from battle wounds.

In 1874, the English chemist Charles Romney Alder Wright performed experiments that involved mixing morphine with different acids. He invented a new chemical called diacetylmorphine, also known as diamorphine or heroin. This drug was similar in structure to morphine but was two to three times stronger.

From:
https://www.therecoveryvillage.com/hero ... s-history/

That said, BAYER used to put heroine in their medication, per that site, until it became illegal.

[Rath Darkblade]

Fair enough, my mistake. Thanks, Tawm!