Keith offers some acute reflections on the story that Rick Perry’s disastrous debate performances resulted from adding big doses of opiate pain relievers to his built-in dumbitude.
As a former sufferer both from long-term, severe back pain and from the haziness produced by oxycodone, I’d like to add an additional thought: if the story is true, it reflects badly not just on Perry’s political advisers, but on his physicians, who neglected a simple step that could have kept him alert.
The drowsiness produced by the opiates is a basic problem in treating chronic pain. For that problem there turns out to be a straightforward solution: reduce the dose of opiates, and add a little bit of amphetamine-type stimulant (ATS). The ATS potentiates opiate pain relief, enabling the lower dose, and directly counteracts the drowsiness.
I discovered this in reading Dan Perrine’s Chemistry of Mind-Altering Drugs. Having spent twenty years deciding almost every day between pain and drowsiness, I was surprised by this, and checked it out with my friend Jerry Jaffe, who writes the section on opiates for Goodman and Gilman. His response? “Yes, of course. Everybody knows that.”
My next question – asked with some asperity – was why, if “everybody knows that,” no doctor had ever given my a little bit of amphetamine along with my oxycodone. Jerry answered, “Think about it. If you take a script for Percodan and a script for Desoxyn down to your corner pharmacy, what’s the first thing the pharmacist does? He calls either the medical board or the DEA and says, ‘Dr. X is writing uppers and downers.’ Then the doctor spends two years trying to keep his license and stay out of jail.”
As a result, I had two decades of needless pain and disability (until I finally let Dr. Gregory Brick fix the underlying problem with his magic scalpel). And, as Keith points out, the people of Texas have an impaired governor, and the Republican Party is about to nominate the Ken doll for President.
The only person I know whose chronic pain was treated according to the textbooks was Lew Seiden. There are advantages of being the chairman of pharmacology at the University of Chicago. But really, should that be a necessary precondition to getting the right treatment?
Seems to me to be about time for (1) the DEA to exercise some self-restraint (or for enforcement against diversion to move from DEA to FDA) and (2) a few doctors to learn some medicine and grow a pair.