Narcotics & sedatives: Take with caution

October 6, 2009

By Norman K. Brown
UTU medical consultant
There is an old saying among physicians that patients will lie more often about their drug usage and their sex lives than about any other topics. So, please, just give me the facts.
What drugs was Michael Jackson taking when he died? Who prescribed them? Why did he have available so many different drugs from so many doctors, and maybe some even via assumed names? How come he received a hospital-use only intravenous sedative in his home?
The recent tragic death of Michael Jackson has once again brought our attention to the double-edged sword of narcotic and sedative drugs. On the one hand, medical providers in their role as healers have prescribed narcotics, such as morphine, and sedatives such as the tranquilizers Valium, Xanax and Ambien to their patients over the years, and hence have given untold numbers of people relief from terrible pain and anxiety and insomnia. On the other hand, serious problems can develop using these drugs.
When a patient with a broken leg receives morphine for the pain, the patient’s brain experiences pain relief. In addition, the patient feels some degree of an altered state of consciousness, which patients describe as anything from very pleasant to obnoxious.
As doses are repeated, two brain/body changes occur:

  1. the brain’s desire for the repeat doses, even if the leg fracture is healing and should be less painful, often increases – called addiction; and,
  2. the body’s chemistry gradually cranks up its chemical destruction of the morphine, so to get the same brain result in the same patient, say a week later, increasing amounts of morphine are required – called tolerance.

Unfortunately, medical providers and their patients sometimes get caught up in a vicious cycle wherein the patient keeps requesting repeated, and often increasing, prescriptions of a given narcotic, when the condition for which it was given should be improving.
The doctor writes prescription after prescription, and addiction and tolerance follow.
Of course, when patients have progressive painful cancer, addiction is not a worry, and, incidentally, it is surprising how little apparent addiction occurs in this situation.
I am trying all day to respond to the needs, anxieties and pains of my patients, and I can understand the pressure Michael Jackson felt inside himself and conveyed to his doctors, as they were trying to respond to his pleas for help with anxiety and sleep .
Many of us have watched clips of Jackson’s rehearsals. He appeared to be in very high state of energy as he put his all into the performances. To get wound down from such high activity and get some sleep before another day — in fact, before many days of these performances — would not be easy for anyone. The Propofol worked. It was dangerous, but I would guess that Michael Jackson kept seeking it.
What can we learn here as consumers and prescribers of narcotics and sedatives?
Although there is a lot of variation, almost any prescriber and almost any patient together can evolve into an addicted patient.
As a prescriber, I need to think twice each time I hand such a prescription to a patient, especially if it is a repeat. As patients, I hope we will ask ourselves, “Do I really need to take another pain pill, and get refills, or can I work myself off of these pills?”
I hope those of us who need some type of pain medication every day are always trying to make life style efforts to reduce the pain without medication, for example using the body differently, exercising, losing weight, getting physical therapy, and even engaging in spiritual activities.
Narcotics and sedatives are a huge blessing for mankind in relieving suffering, but we always need to stay vigilant to keep them from doing more harm than good.
(To see other medical advice columns by Dr. Brown, click here: