© 2013 by Remay Ningano Nymous
And so unmeasureable is the ambition of princes, that he seemed to think of nothing less than reducing the whole empire of Blefuscu into a province, and governing it, by a viceroy; of destroying the Big-endian exiles, and compelling that people to break the smaller end of their eggs, by which he would remain the sole monarch of the whole world.
Gulliver's Travels by Jonathan Swift, published 1726.
Omeprazole is terrific. My stomach was hurting. Every time I ate something, a little while later I would feel nauseous. I had to vomit it up. I wasn't getting any nourishment. I had no energy. I made an appointment with a doctor. He dropped a little video camera down into my stomach, at the end of a string, and took a look at what was inside my stomach and duodenum. Turns out I had a bunch of ulcers. He prescribed some omeprazole. Fantastic! I was able to eat again! Omeprazole: coolest thing since slight bread. OK. I've been taking omeprazole for 13 years now. Every time I try to stop taking it, for more than a day or two, my stomach problems come back. If I want to keep my stomach problems at bay for the rest of my life, I may probably have to take omprazole for the rest of my life. There may be some "side" effects. But it seems to nearly everyone that the beneficial effects are worth the risks. My doctor doesn't think twice about prescribing a months's supply of omeprazole with 11 refills, every time I visit him.
Opium (or morphine) is terrific. I was having nasty pain in a few parts of my face. Day after day, if it didn't hurt when I woke up, it would start hurting a few hours later. It would slowly spread to my whole face, and then to my whole head - over the course of a few hours. I made an appointment with my doctor. He took a look at my eyes, my ears, my mouth, my nose, my throat. He didn't see anything wrong. I did have a little chancre sore, on my palate. Stung like hell. He didn't notice it. He prescribed some drugs anyway, despite not finding anything wrong. They didn't help. I heard that opium or morphine might help. I tried morphine. Fantastic! My eyes stopped hurting. My face stopped hurting. I was able to get out of bed and go to work, tune pianos. Morphine — coolest thing since sliced bread. I've been taking morphine for about 14 years now. Every time I try to stop taking it, for more than a day or two, my face pain comes back. I have not increased the dose over the last 5 years. If I want to keep the face pain at bay for the rest of my life, I may probably have to take morphine for the rest of my life. There may be some "side" effects. And it seems to nearly everyone that the beneficial effects are not worth the risk. Huh? Why is that? Why does nearly everyone think the benefits of omeprazole are worth the risks, and why do so many people think that the benefits of opium are not worth the risk? And my doctor will only prescribe a month's supply of morphine at a time. Why are so many people so concerned about the possible bad effects of opium, that they would rather have people remain in pain than take opium, and would compel them not to take it? For the same reason that the viceroy of the Small-endians compelled the big-endians to break the small end of their eggs - so that he could remain the monarch.
With the omeprazole, my doctor knew exactly how much would do the trick. I took the same amount, at the same time, once a day, every day. Within about 10 hours of taking the first dose, I was feeling a lot better. With morphine, the dosing was a little different. I took some, I still hurt, I took some more, I still hurt, I took some more: bam, the pain was gone. I felt alright for quite a while. About 8 hours. I enjoyed tuning the piano, and was thankful I could pay attention to my job, and earn a few dollars. I took a rest. Next day, I took some morphine just as the pain was starting, before it got real bad; I didn't have to take as much as yesterday. Some days I didn't need any. Some days, I needed a little more than usual. This has been going on for 14 years now. The first year, my daily dosage gradually increased. Then it leveled off. I have been taking the same amount per month now, for about 5 years. For omeprazole - all 13 years.
I looked up the manufacturer's official prescribing information for both drugs. Here's the link for omeprazole; here's the link for morphine (if you click where it says "prescribing information" you'll be able to open or download the PDF file). Here's a source of more info on lots of drugs. Let's go over the main points. While we're at it, let's take a look at the manufacturer's official prescribing information for another analgesic, other than morphine - here, have a look at the official prescribing information for ibuprofen. It is popular to point out that morphine can cause osteoporosis. And now it looks like doctors are finding out that so can omeprazole. Ibuprofen can help a bit with mild to moderate pain. It can't control pain anywhere near as well as can morphine.
Shit, look at this, if you take enough morphine - if one day you take considerably more than the dose you are accustomed to - it may cause you to stop breathing, and die. Dam, if you take ibuprofen - you can get a stomach hemorrhage and bleed to death. Suddenly, without warning, even though you took only the same dose you took yesterday, or took even less. OK, good news, if your pain gets worse and worse, you can gradually increase your dose of morphine, and do so safely. You can increase your dose of ibuprofen too. A little bit, anyway. Up to about 4 times the starting dose. Any more than that, and you risk killing off your kidneys.
Morphine has a wider range of doses that are therapeutic, than omeprazole. 20 to 40 mg of omeprazole every day, does the trick for just about everyone. A few people need a little more. With morphine, the dose can vary from 40 mgs to over 400 mgs. A few people need more, maybe a lot more.
There must be a reason why doctors are reluctant to prescribe morphine, but eager to prescribe NSAIDs like ibuprofen. The question is: is the reason because of the comparative safety and efficacy? Or is it something else?
Maybe it is something that has nothing to do with medicine, like for example, maybe NSAIDs's are cheaper? No, that's not it? Let's look into things further.
Opioids and Lipitor
Going off opioids is often painful, anxiety-inducing, and difficult. Going off Lipitor will endanger your life.
Sounds like it might be a good reason not to take Lipitor in the first place if you've been having chronic high cholesterol: if in the future, you should decide you want to go off Lipitor, it will cause your cholesterol levels to go up, and this will endanger your life. Huh? This a reason that one should not take Lipitor in the first place? I don't think there are many people will agree. But if you are talking about opioids, you tend to hear about a different way of thinking.
Video on you tube, woman describing opioid withdrawal: "Anybody who's been on opioids for a long enough period of time knows that you just don't say 'no well I've had enough of this, I'm not going to do this anymore today, I just won't take my pills tomorrow,' like 'I won't take my Lipitor tomorrow,' that doesn't work, next day, you're very very sick, if you don't take those pills. Excellent description of withdrawal symtoms. Indded, it might be a good reason not to start taking opioids in the first place if you've been having long-term chronic pain: if in the future you should you decide you want to go off opioids, it will cause pain and anxiety. This is an idea that is worthy of consideration, before you start taking opioids. But the alternative is also a valid idea worthy of consideration: that the relief from chronic pain, may be worth staying on opioids for life. Yet the same people who cite the difficulty of going off opioids, as a reason for not starting opioids, don't cite the difficulty of going off Lipitor, as a reason for not starting Lipitor. They know that once you start Lipitor, you are most likely going to need it for the rest of your life, and they are resigned to it. So why don't they think the same thing about opioids for chronic pain?
Once you start Lipitor, you may need to stay on it for the rest of your life. The same is true for opioids. A reasonable conlusion is that doctors should not give Lipitor to people with chronic high cholesterol, who are able to control their cholesterol by other means, and that doctors should not give opioids to people with chronic pain, who are able to control their pain by some other method. But for chronic high cholesterol, people may need to take Lipitor for the rest of their life. It would be better if they didn't have to, but the benefits often make it seem worthwhile. For chronic pain, people may need to take opioids for the rest of their life. It would be better if they didn't have to, but the benefits often make it seem worthwhile. For short term pain, opioids may be prescribed for a short time. If you have been taking opioids for a short time, when you go off opioids, it will not be difficult.
Morphine, codeine and many of the semisynthetic opioids are comparably priced to even generic Lipitor. Many opioids have less side effects than Lipitor. Why are so many people worried so much about years of opioid use, but not worried about years of Lipitor use?
I think the reason is cultural, and I think the reason has nothing to do with the facts, the science, relating to both drugs. In certain cultures, opioid use has a bad connotation, while simultaneously, Lipitor does not. These are culturally-created connotations that have nothing to do with scientific inquiry, or reality. The Bigendians always crack their eggs at the big end; the un-opioiders always say no to opioids. "That is who we are" – and they will snub anyone who isn't like them. The Little Endians always crack their eggs at the little end. They are each convinced that members of the other group are doing things the wrong way. The big endians stick together. The little endians stick together. Hatred for the other is a source of camaraderie. They seem to think this is a good thing. They even make war on the other group.